Effective Use of NCD, LCD, and NCCI Edits for

Clean Claims
Presented By Trenda Davis, CPC, Auditor; SuperCoder.com

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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

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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.

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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
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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

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Example of PTP Edit

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Example of PTP Edit

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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

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Example

Your practice bills CPT code 11004 with 3 units

Will this claim be paid or denied?

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National Correct Coding Initiative
CCI-associated modifiers include:
Anatomical Modifiers: Other Applicable Modifiers:
TA-T9 Modifier - 27, 59, 91, XE,
FA-F9 XS, XP, XU
E1-E4
LT and RT
Global Surgery Package:
Modifier - 24, 25, 57, 58,
78, 79
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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.

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http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
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National Correct Coding Initiative

Organized in Two Tables:

Column 1 / Column 2 Correct Coding Edits
Mutually Exclusive Code (MEC) Edits

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Example

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Example

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