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 Post subject: NCCI correct coding
PostPosted: Wed Oct 11, 2017 12:18 pm 
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Joined: Sat Oct 11, 2014 11:40 am
Posts: 155
Location: Boston, MA
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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 Post subject: Re: NCCI correct coding
PostPosted: Thu Oct 12, 2017 8:15 am 
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Joined: Wed Apr 04, 2007 10:11 pm
Posts: 4003
Location: Springfield, MO
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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Gavin Walker
Walker Tek Solutions, LLC
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 Post subject: Re: NCCI correct coding
PostPosted: Thu Oct 12, 2017 12:47 pm 
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Joined: Sat Oct 11, 2014 11:40 am
Posts: 155
Location: Boston, MA
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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 Post subject: Re: NCCI correct coding
PostPosted: Fri Oct 13, 2017 9:56 pm 
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Joined: Wed Apr 04, 2007 10:11 pm
Posts: 4003
Location: Springfield, MO
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.


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 Post subject: Re: NCCI correct coding
PostPosted: Sat Oct 14, 2017 9:44 am 
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Joined: Fri Mar 11, 2011 6:59 pm
Posts: 221
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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Steven Zats
Medical Billing Professionals


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 Post subject: Re: NCCI correct coding
PostPosted: Mon Oct 16, 2017 8:29 am 
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Joined: Wed Apr 04, 2007 10:11 pm
Posts: 4003
Location: Springfield, MO
Who is the insurance carrier and is this combination of codes valid for Medicare?


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 Post subject: Re: NCCI correct coding
PostPosted: Mon Oct 16, 2017 9:59 am 
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Joined: Fri Mar 11, 2011 6:59 pm
Posts: 221
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

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Steven Zats
Medical Billing Professionals


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