2022 first and second quarter NCCI edit updates
Derm Coding Consult
By Tiffany McFarland, RHIT, Analyst, Coding & Reimbursement, August 1, 2022
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CMS has released its first and second quarterly updates to the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits. Versions 280.2 and 281.0 went into effect on Jan. 1, and April 1, 2022.
NCCI PTP edits overview
The NCCI PTP code pair edits are designed to prevent improper payments due to inappropriate reporting of services. Specifically, reporting two procedures that cannot be performed during the same patient encounter because the two procedures are mutually exclusive based on anatomic location, temporal conditions, or gender. Although the NCCI edits are developed for use by Medicare Administrative Contractors (MACs) during claim adjudication, private payers may follow the same guidelines and policies for their claim adjudication. Please check directly with private payers for specific guidance on the appropriate use of NCCI-associated modifiers for claims submitted to them for processing, as these may vary from Medicare.
The NCCI edit table is comprised of a list of Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) code combinations. The NCCI includes one table of edits for physicians and non-physician clinicians (NPCs) and one table of edits for outpatient hospital services.
2022 first and second quarter NCCI coding updates
There are no dermatology-related NCCI edits for the first and second quarters. However, periodic reviews of the NCCI table are essential for dermatology practices to ensure that the appropriate modifier(s) are appended to the appropriate code(s), where applicable, and to avoid unnecessary claim denials due to missing or inappropriate use of modifiers.
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Correct Coding Modifier Indicators (CCMI)
The Column One/Column Two Correct Coding edit tables contain a modifier indicator column known as the Correct Coding Modifier Indicator (CCMI). The CCMI determines whether an NCCI-associated modifier will permit the code pair to bypass the edit.
A modifier indicator of “0” means no NCCI-associated modifier will bypass the edit(s). Therefore, appending a modifier to the procedure code would be considered inappropriate.
A CCMI “1” means an NCCI-associated modifier may be used to bypass the edit(s) under specific circumstances.
A modifier indicator of “9” means the use of NCCI-associated modifiers is not specified and/or that the effective date of the NCCI instruction is the same as the date it was deleted.
The following table includes examples of some dermatology code combinations reflecting CCMI indicators:
Column 1 | Column 2 | Effective date | Deletion date | Modifier | PTP edit rationale |
|---|---|---|---|---|---|
99213 |
99358 |
20210101 |
* |
0 |
CPT Manual or CMS |
69100 |
11102 |
20190101 |
* |
1 |
Mutually exclusive |
11201 |
10060 |
19960101 |
19960101 |
9 |
Standards of medical/ |
Key: * = no data, 0 = not allowed, 1 = allowed, 9 = not applicable
Inappropriate use of NCCI edits
The coding team frequently receives member coding inquiries for claim denials due to inappropriate use of modifiers. A common trend of the inappropriate usage of the NCCI edits occurs when destructions are performed on two pre-malignant lesions on the same day as a destruction and shave removal of two distinct benign lesions. In addition, a tangential biopsy performed to a separate lesion is reported on the same date of service (DOS) as the destructions and shave removal by the same provider.
According to NCCI edit guidance, this claim would be reported as follows:
17110 (destruction, benign lesion(s),
1-14 lesions)
11102-59 (tangential skin biopsy)
1130x-59 (lesion removal by shave
technique)
17000-59 (destruction, pre-malignant lesion,
1st lesion)
17003-59 (destruction, pre-malignant lesion, 2nd lesion)
| Column 1 | Column 2 | Modifier |
|---|---|---|
|
17110 |
17000 |
1 |
|
17110 |
17003 |
1 |
|
17110 |
11300 |
1 |
|
17110 |
11102 |
1 |
Key: 0 = not allowed, 1 = allowed, 9 = not applicable
More information on the appropriate use of NCCI Edits can be found and reviewed in the CMS NCCI Policy Manual.
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