Health Information Management

Tip: The three types of NCCI edits

APCs Insider, October 25, 2013

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The NCCI Manual includes instructions for reporting modifiers to bypass ­bundling edits. Coders can choose from 35 modifiers—when appropriate—to bypass bundling guidelines, ­according to CMS. NCCI includes three types of edits:

  • Procedure-to-procedure edits
  • Medically unlikely edits (MUE)
  • Add-on code edits

Procedure-to-procedure edits represent two codes that generally should not be reported together.

MUEs total the maximum units of service that CMS has deemed appropriate for a particular service, while add-on code edits require the proper parent code to be billed correctly. While CMS publishes all of the procedure edits, it only publishes some of the MUE edits.

CMS updates the list of add-on codes with their primary procedure codes on an annual basis based on changes to the CPT Manual, with quarterly updates issued, as necessary, via a Change Request.

This tip is adapted from “Experts weigh in on proper use of modifier -59” in the October issue ofBriefings on APCs.



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