Health Information Management

Tip: Understand NCCI edits

APCs Insider, March 26, 2010

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CMS introduced NCCI edits for outpatient therapy in 1996 to prevent improper payment when incorrect code combinations are reported. These edits apply to code combinations in which one of the codes may be a component of a more comprehensive code or when a code is mutually exclusive of another code in the pair. CMS updates the edits quarterly.

The NCCI edits are displayed in two sets of tables, both of which have two columns. The first table, titled “Column 1 & Column 2,” lists CPT codes under Column 1 that are considered to be comprehensive services, whereas Column 2 lists CPT codes considered to be included in the comprehensive services listed in the corresponding rows in Column 1.
 
The same holds true for the table titled Mutually Exclusive. These edits allow for payment only for the Column 1 code unless you correctly append modifier -59.
 
This tip was adapted from “Should you override that outpatient therapy NCCI edit?”
in the April issue of Briefings on APCs.



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