Effective Use Of NCD, LCD, and NCCI Edits for Clean Claim
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The document outlines the effective use of NCD, LCD, and NCCI edits for submitting clean claims, focusing on definitions and their significance in coding. It details the purpose of the National Correct Coding Initiative, including procedure-to-procedure edits and medically unlikely edits that prevent improper payments for specific CPT codes. The document also emphasizes the importance of staying updated with coding changes and utilizing correct coding methodologies.
Effective Use Of NCD, LCD, and NCCI Edits for Clean Claim
- 1. Effective Use of NCD, LCD, and NCCI Edits for Clean Claims Presented By Trenda Davis, CPC, Auditor; SuperCoder.com 1
- 2. 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
- 3. 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
- 4. 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
- 5. 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
- 6. Example of PTP Edit 6
- 7. Example of PTP Edit 7
- 8. 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
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- 10. Example Your practice bills CPT® code 11004 with 3 units Will this claim be paid or denied? 10
- 11. 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
- 12. 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
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- 17. National Correct Coding Initiative Organized in Two Tables: • Column 1 / Column 2 Correct Coding Edits • Mutually Exclusive Code (MEC) Edits 17
- 18. Example 18
- 19. Example 19