Ensure Your Coding is Correct with Medicare National Coding Initiative Edits (NCCI)

Codes Discussed: 00000-01999 (Anesthesia Services CPT code range), 10000-19999 (Surgery: Integumentary CPT code range), 20000-29999 (Surgery: Musculoskeletal CPT code range), 30000-39999 (Surgery: Respiratory, Cardiovascular, Hemic and Lymphatic CPT code range), 40000-49999 (Surgery: Digestive CPT code range), 50000-59999 (Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery CPT code range), 60000-69999 (Surgery: Endocrine, Nervous, Eye and Ocular Adnexa, and Auditory CPT code range), 70000-79999 (Radiology CPT code range), 80000-89999 (Pathology and Laboratory CPT code range), 90000-99999 (Medicine and E/M CPT code range), A0000-V9999 (Supplemental HCPCS Level II code range), 0001T-0999T (Category III code range), 25500 (Closed treatment of radial shaft fracture), 90765 (IV therapy code referenced in deleted PTP edit example), 70130 (Radiologic examination, mastoids, complete, minimum of 3 views per side), 70120 (Radiologic examination, mastoids, less than 3 views per side), LT modifier (Left side anatomical modifier), RT modifier (Right side anatomical modifier), modifier 59 (Distinct procedural service), modifier XS (Separate structure), 62140 (Cranioplasty for skull defect, up to 5 cm diameter), 62141 (Cranioplasty for skull defect, larger than 5 cm diameter), modifier XE (Separate encounter), 43270 (EGD, flexible, transoral, with ablation of tumor, polyp, or other lesion), 43756 (Duodenal intubation and aspiration, diagnostic, including image guidance, single specimen), 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis, complex/manual or mechanical technique), 66940 (Removal of lens material, extracapsular), 46262 (Hemorrhoidectomy, internal and external, 2 or more columns/groups), 64510 (Injection of anesthetic agent, stellate ganglion), 32661 (Surgical thoracoscopy with excision of pericardial cyst, tumor, or mass), 32601 (Diagnostic thoracoscopy, separate procedure, lungs, pericardial sac, mediastinal or pleural space, without biopsy), 68510 (Biopsy of lacrimal gland), 10021 (Fine needle aspiration biopsy without imaging guidance, first lesion), 52648 (Laser vaporization of prostate, including control of postoperative bleeding, complete), 53660 (Dilation of female urethra including suppository and/or instillation, initial), 29827 (Shoulder arthroscopy with rotator cuff repair), 29820 (Shoulder arthroscopy with partial synovectomy), 11740 (Evacuation of subungual hematoma), 11900 (Intralesional injection, up to and including 7 lesions), A6460 (Synthetic resorbable wound dressing, sterile, pad size 16 square inches or less), 40819 (Excision of frenum, labial or buccal), 77334 (Treatment devices, design and construction, complex), modifier 50 (Bilateral procedure), FA modifier (Left hand, thumb), F1-F9 modifiers (Left/right hand digit modifiers), TA modifier (Left foot, great toe), T1-T9 modifiers (Left/right foot digit modifiers), E1-E4 modifiers (Eyelid anatomical modifiers), modifier 76 (Repeat procedure or service by same physician or other qualified health care professional), modifier 77 (Repeat procedure by another physician or other qualified health care professional), modifier 91 (Repeat clinical diagnostic laboratory test), 64901 (Nerve graft add-on code), 64885-64893 (Primary nerve repair codes referenced as acceptable primary codes for add-on code 64901), 64727 (Internal neurolysis add-on code), 90935 (Hemodialysis procedure with single evaluation), 90937 (Hemodialysis procedure requiring repeated evaluations), 90945 (Dialysis procedure other than hemodialysis with single evaluation), 90947 (Dialysis procedure other than hemodialysis requiring repeated evaluations), G0491 (Dialysis procedure at ESRD facility for acute kidney injury without ESRD), G0492 (Dialysis procedure at ESRD facility for acute kidney injury without ESRD requiring repeated evaluations), modifier 25 (Significant, separately identifiable E/M service), 90999 (Unlisted dialysis procedure), CG modifier (Policy criteria applied), KX modifier (Requirements specified in medical policy have been met), HCPCS modifier XE (Separate encounter), HCPCS modifier XS (Separate structure), HCPCS modifier XP (Separate practitioner), HCPCS modifier XU (Unusual non-overlapping service), 99418 (Prolonged service add-on code referenced in add-on code context)

Topics Covered: Medicare National Correct Coding Initiative edits, NCCI coding edits, NCCI program purpose, Medicare correct coding, improper coding prevention, procedure-to-procedure edits, PTP edits, medically unlikely edits, MUE edits, add-on code edits, AOC edits, CMS NCCI Policy Manual, NCCI Manual Chapter 1, HCPCS coding instructions, CPT coding instructions, Category III code instructions, Medicare coding policy, commercial payer NCCI adoption, CMS versus CPT coding guidance, CPT Assistant Medicare billing limitations, MAC claim processing criteria, hospital PTP edit tables, practitioner PTP edit tables, quarterly NCCI edit updates, outpatient hospital NCCI edits, practitioner NCCI edits, ASC NCCI edits, Outpatient Code Editor, OCE edits, OPPS billing edits, type of bill NCCI edits, SNF Part B therapy edits, CORF edits, outpatient therapy provider edits, home health agency claim edits, column 1 column 2 code pair tables, PTP column 1 payable code, PTP column 2 denied code, same patient same date same provider edits, PTP effective date, PTP deletion date, correct coding modifier indicator, CCMI, PTP edit rationale, NCCI PTP-associated modifiers, anatomical modifiers, global surgery modifiers, modifier 59 guidance, X modifiers, XE modifier, XS modifier, XP modifier, XU modifier, repeat procedure modifiers, modifiers 76 and 77 not PTP-associated, CCMI 0, CCMI 1, CCMI 9, documentation supporting modifier use, HCPCS CPT procedure code definition edit, redundant service edits, mutually exclusive procedure edits, misuse of column two code with column one code, more extensive procedure edits, standards of medical and surgical practice edits, integral services, local anesthesia bundling, regional anesthesia bundling, CPT separate procedure definition, diagnostic thoracoscopy bundling, surgical thoracoscopy coding, sequential procedure edits, failed surgical approach coding, gender-specific procedure edits, sex-specific CPT codes, missing PTP edit table limitations, correct coding despite no edit, AMA CPT publication review, society coding instructions, appropriate modifier use, inappropriate modifier use, shoulder arthroscopy NCCI edits, rotator cuff repair and synovectomy edits, subungual hematoma coding, intralesional injection bundling, MUE definition, maximum units of service, units of service edits, same provider same patient same date MUE, practitioner MUE tables, DME supplier MUE tables, facility outpatient MUE tables, outpatient hospital MUE tables, MUE values, MUE adjudication indicator, MAI, MUE rationale, confidential MUE values, fraud and abuse concerns with MUEs, MAI 1 claim line edit, MAI 2 absolute date of service edit, MAI 3 date of service clinical benchmark edit, appealable MUE denials, claim line modifier reporting, anatomic modifiers for MUEs, bilateral procedure MUE reporting, ASC modifier 50 restriction, MUE auto-deny edits, bilateral surgery indicator, Medicare Physician Fee Schedule MUE logic, add-on code definition, add-on code primary procedure requirement, CPT plus symbol, global surgery period ZZZ, Type 1 add-on code edits, Type 2 add-on code edits, Type 3 add-on code edits, contractor-defined primary codes, MAC-defined primary procedure codes, add-on code overpayment risk, NCCI with LCD policies, NCCI with NCD policies, LCD coding articles, Medicare coverage requirements, reasonable and necessary services, OPPS packaging edits, NCCI precedence over AMA guidance, NCD national coverage conditions, LCD local coverage determinations, hemodialysis NCCI example, E/M bundled to dialysis procedure, unrelated E/M with modifier 25, hemodialysis frequency coverage, covered ICD-10-CM diagnosis requirements, dialysis CPT and modifier reporting, ultrafiltration monitoring coverage, Medicare Claims Processing Manual, Medicare NCCI FAQ Library, Medicaid NCCI versus Medicare NCCI, modifier 59 abuse risk, modifier 59 alternatives, NCCI coding compliance, Medicare billing compliance, NCCI audit risk, NCCI webinar content