NCCI correct coding

Technical problems with Medisoft.
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drk
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NCCI correct coding

Post by drk » Wed Oct 11, 2017 12:18 pm

With the latest RM update, we have started getting NCCI correct coding edits for consults -- 99241 to 99245 consultations from United and Unicare, to name a couple.

United has since postponed the implementation of this edit and Unicare does not enforce this edit either. How do I override this edit and tell RM to not flag procedure 99244 as an error?

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Gavin Walker
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Re: NCCI correct coding

Post by Gavin Walker » Thu Oct 12, 2017 8:15 am

In Revenue Management you can go to Configure -> Insurance -> Assign Edits and then un-check the CCI edits for those particular insurance and then click Save.
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drk
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Re: NCCI correct coding

Post by drk » Thu Oct 12, 2017 12:47 pm

What about the other CCI edits? I don't want to lose them all. Is there a list/report of what edits are in each category? I am only able to see the "Common Rules."

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Gavin Walker
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Re: NCCI correct coding

Post by Gavin Walker » Fri Oct 13, 2017 9:56 pm

Unfortunately, it is kind of an all or nothing thing. We can't pick and choose which of the CCI edits are done for each payer.

mbpros
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Re: NCCI correct coding

Post by mbpros » Sat Oct 14, 2017 9:44 am

Hey, Gavin: The other CCI Edits are not valid either. For example, if I billed a 99214 with other codes (like 98940 and 97110) and I had a 25 modifier for the 99214 (which is correct), I would get a CCI Error.

If I billed 98940 and 97140 with a 59 modifier, I also would get an error for CCI for both the 98940 and the 97140-59 which is not correct.

How can this be fixed so the CCI Edits are actually correct? You should never get an error message when you use a 25 modifier with a 99214 with other codes...and same for the 98940/97140-59 combination.

Steve
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Medical Billing Professionals

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Gavin Walker
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Re: NCCI correct coding

Post by Gavin Walker » Mon Oct 16, 2017 8:29 am

Who is the insurance carrier and is this combination of codes valid for Medicare?

mbpros
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Re: NCCI correct coding

Post by mbpros » Mon Oct 16, 2017 9:59 am

Happening with all payers. For example, if I bill 98940, 97140-59 and 97035, it says that a modifier is required for 98940. But that is not correct. Same thing if I bill 99214 with a 25 modifier with other codes.

First, 98940 does NOT require a modifier when being billed with 97140-59 and 97035 under CCI Edits (an AT modifier is needed for Medicare but that is not a CCI Edit).

Second, when billing an exam code like 99214, I am getting the error even though I do have the valid 25 modifier listed.

Steve
Steven Zats
Medical Billing Professionals

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