Use Of NCCI Edit In Radiology

1
Use Of NCCI Edit In
Radiology
2
Use Of NCCI Edit In Radiology
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 Associations 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.
3
Use Of NCCI Edit In Radiology
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 CMSs
How to use Medicare National Correct Coding
Initiative (NCCI) Tools? Are You Ready to Get
Billing from Best Medical Billing Company? Want
to hire an experts in Medical billing and coding
for your Practice? You are at the right place,
what you need now is a partner who can finish out
the rest of the work and make the technology and
implementation just as simple. Thats what the
best medical billing company like Medisys Data
Solutions Inc. can do. If youre ready to get
started, schedule a meeting with our Medical
Billing Manager from filling out enquiry form
from our website!
4
(No Transcript)