Effective use of ncd lcd and ncci edits for clean claims

Effective Use of NCD, LCD, and NCCI Edits for Clean Claims Presented By Trenda Davis, CPC, Auditor; SuperCoder.com

1

Course Objective • Definition of NCCI (CCI), NCD and LCD and their importance • How NCCI edits impact CPT coding • ICD-10-CM updates that will affect NCD and LCD • Helpful tips to send out clean claims • Learn tools and resources that will help with the up-to-date coding changes 2

National Correct Coding Initiative • National Correct Coding Initiative (NCCI) • Correct Coding Initiative (CCI) • Created by CMS to “promote national correct coding methodologies and to control improper coding leading to inappropriate payments on Part B claims.”

3

National Correct Coding Initiative Purpose of NCCI: • Prevent providers from reporting two procedures together for which there is a third separate code that describes the combination of services • Require providers to report the complete procedure code instead of reporting multiple codes that describe parts of the complete procedure • Require providers to report only the more extensive version of the procedure performed 4

National Correct Coding Initiative Procedure to Procedure (PTP) edits • Automated prepayment edits that prevent improper payment when certain codes are submitted together for Part B covered services.

• 2 provider type choices: • Practitioner • Hospital 5

Example of PTP Edit

6

Example of PTP Edit

7

National Correct Coding Initiative Medically Unlikely Edits (MUE) • Maximum number of units of services allowable under most circumstances for a single HCPCS/CPT code billed by a provider on a date of service • 3 provider type choices: • Practitioner • Durable Medical Equipment • Facility Outpatient 8

9

Example Your practice bills CPTÂŽ code 11004 with 3 units Will this claim be paid or denied?

10

National Correct Coding Initiative CCI-associated modifiers include: • Anatomical Modifiers: • TA-T9 • FA-F9 • E1-E4 • LT and RT • Global Surgery Package: • Modifier - 24, 25, 57, 58, 78, 79

• Other Applicable Modifiers: • Modifier - 27, 59, 91, XE, XS, XP, XU

11

National Correct Coding Initiative Updated Quarterly: • • • •

1st Quarter: January 1st - March 31st 2nd Quarter: April 1st - June 30th 3rd Quarter: July 1st - September 30th 4th Quarter: October 1st - December 31st

• Make sure your practice is aware of update changes to ensure your practice has efficient and clean claims submission.

12

13

14

15

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html 16

National Correct Coding Initiative Organized in Two Tables: • Column 1 / Column 2 Correct Coding Edits • Mutually Exclusive Code (MEC) Edits

17

Example

18

Example

19