NCCI Edits: Top Ways to Collect When CCI Comes Calling

From time to time it seems like just as you’re preparing your practice for optimal coding efficiency, an untoward incident happens that throws a wrench in the works. Such is the case with the latest version of the Correct Coding Initiative, which has launched several new bundles that are bound to impact optometry practices across the country.

Expect Denials for 99173, E/M Codes

CCI version 22.2, which went into effect on July 1, now bundles 99173 (Screening test of visual acuity, quantitative, bilateral) into the office-based E/M codes 99201-99215.

In addition, CCI now bundles 65760 (Keratomileusis), 65765 (Keratophakia), 65767 (Epikeratoplasty), and 65771 (Radial keratotomy) into 92025 (Computerized corneal topography, unilateral or bilateral, with interpretation and report).

All of the new edits referenced above have an indicator of “1.”

What this means: Typically, an indicator of “1” means that you can use a modifier to bypass the edits, particularly in cases when your documentation can prove that the bundled, or “column 2” service was a distinctly separate service. For instance, it would apply if you billed the column 1 code for the left eye and the column 2 code for the right eye. However, there’s more to separating the edits than just sticking a modifier on the column 2 code and moving on.

Investigate Before Modifying

If you come across a CCI edit that has a “1” indicator on it, your first step should be to perform a bit of research, says Linda R. Farrington, CPC, CPMA, CPC-I, CRC, owner of Medisense, a medical coding consulting firm.

“The first thing that I would do is to look at the guidelines and instructional notes in CPT both at the beginning of the section (there are six in CPT Category I codes), the subsection, and also any parenthetical instructions beneath the code itself,” Farrington says.

She also reminds practices that not all payers utilize CCI. “It was originally developed for use by Medicare but has been adopted for use by some commercial payers,” she says. “Some payers have created their own, unique bundling edits. So, depending on the payer, you would want to apply the bundling edits that they would be using to adjudicate the claim.”

For more on NCCI edits and a review of the Q-4 Updates, join expert speaker Kim Garner-Huey in a Live Webinar on Thu, Oct 06, 2016. This session will take you to the source of the NCCI information and explain its correct application – as well as the consequences of not understanding and applying the information correctly.

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