CMS updates 2021 first and second quarter NCCI edits
Derm Coding Consult
By Tiffany E. McFarland, RHIT, coding analyst, coding & reimbursement, July 1, 2021
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CMS has released the first and second quarter updates to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits: Version 27.0, which went into effect Jan. 1, 2021, and version 27.1, which went into effect April 1, 2021.
CMS National Correct Coding Initiative edits overview
The NCCI PTP code pair edits are designed to prevent improper payments when incorrect code combinations are reported together for Medicare Part B and most private payer covered services. The NCCI PTP table includes a list of correct code edits for physicians and non-physician clinicians (NPCs).
The table is comprised of a list of Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) code combinations that are mutually exclusive from one another. In other words, if one of those mutually exclusive codes are reported together on the same day by the same physician or NPC for the same patient, one of the services would be bundled into the primary procedure and denied payment.
2021 first and second quarter NCCI coding updates
The NCCI program undergoes continuous refinement. Medicare Administrative Contractors (MACs) implement the new versions effective Jan. 1, April 1, July 1, and Oct. 1 of each year. While the first and second quarter of 2021 do not have dermatology-related updates or changes, it is important to understand the impact of these updates for the future.
It is vital to the revenue cycle to become familiar with the NCCI Edits to save time and resources for proper claim submission. When CPT code pairs are denied based on NCCI PTP edits, physicians or NPCs cannot balance bill Medicare or Medicaid beneficiaries as this qualifies as an example of incorrect coding practices.
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Correct Coding Modifier Indicators (CCMI)
The table is formatted by columns that provide a clear and concise visualization of the code combinations that may or may not be reported together with the appropriate modifiers by a CCMI.
This indicator determines whether an NCCI-associated modifier will permit the code pair to bypass edits. A modifier indicator of a “0” means no modifiers associated with the NCCI may be used to bypass the edit(s), and a “1” means modifiers associated with NCCI may be used to bypass the edit(s) under specific circumstances. See the table below for additional details and examples. More information can be found at this CMS NCCI edits page.
| CCMI | CCMI descriptor | Code combination example column 1 | Code combination example column 2 | Rationale | Resolve |
|---|---|---|---|---|---|
0 |
An NCCI-associated modifier is not allowed and will not bypass the edit |
11104 |
11102 |
CPT |
Codes with this CMMI cannot be paid for the same patient on the same DOS by the same physician or NPC. Only one primary skin biopsy code can be reported on the same DOS. The punch biopsy is reported as primary code; report an add-on code for the tangential biopsy (e.g., 11103). |
1 |
An NCCI-associated modifier is allowed and will bypass the edit |
11102 |
17000 |
Mutually exclusive procedures |
Edit can be bypassed and the column two code may be eligible for payment if an NCCI-associated modifier is appropriately appended to one of the codes. |
9 |
The use of NCCI-associated modifiers is not specified. This indicator is used for all code pairs that have a deletion date that is the same as the effective date |
13100 |
13153 |
Misuse of column two code with column one code |
This indicator was created so that no blank spaces would be in the indicator field. For example, the edit for code combination 13100 and 13153 went into effect on 05/06/2000 and was deleted on the same day making the edit obsolute. |
Also, visit the AADA Coding Resource Center to find practical tips, tools, quizzes, and videos about common dermatologic coding issues at staging.aad.org/coding.
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