According to CMS, they developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The Centers for Medicare & Medicaid Services (CMS) owns the NCCI program and is responsible for all decisions regarding its contents. The CMS developed its coding policies based on coding conventions defined in the American Medical Association’s CPT Manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The CMS annually updates the National Correct Coding Initiative Policy Manual for Medicare Services. The NCCI Policy Manual should be used by Medicare Administrative Contractors (MACs) as a general reference tool that explains the rationale for NCCI edits.
As we all know that there are some procedures, which have to be coded with modifiers to share more information regarding the procedure performed. There are many such procedures can be done on same day if diagnosis is not found in one report, hence such procedures overlap each other and the payment to the physician can be impacted. So, to resolve this overlap situation medical coders need to use modifiers to modify the procedures and give certain critical information performed before, during or after the procedures.
Medical coders in radiology while coding code X-rays of chest, abdomen, spines etc. and sometimes coders come across many CCI edits situations. Many times coders face such edits in X-rays of chest. Whenever there are two view of check CPT 71046 performed with one view of chest CPT 71045 on same day, there is CCI edits involved. In such cases medical coders can use 59 modifier to bypass the edits with low RVU CPT that is one view of chest X ray CPT 71045.
Do not Use Modifiers in Below Procedure Codes
There are few cases in Radiology when medical coders are not allowed to use modifier to any procedure because that complete procedure is involved in the primary procedure. So, according to payers in such cased only primary procedure will be get paid even if other procedure is present. Other procedure will get denied by payer when it is totally inclusive in the primary procedure.
To know more about NCCI Edits you can refer CMS’s – How to use Medicare National Correct Coding Initiative (NCCI) Tools?
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