The document outlines the effective use of NCD, LCD, and NCCI edits for submitting clean claims, focusing on definitions and their significance in coding. It details the purpose of the National Correct Coding Initiative, including procedure-to-procedure edits and medically unlikely edits that prevent improper payments for specific CPT codes. The document also emphasizes the importance of staying updated with coding changes and utilizing correct coding methodologies.

1. Effective Use of NCD, LCD, and NCCI Edits for
Clean Claims
Presented By Trenda Davis, CPC, Auditor; SuperCoder.com
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2. Course Objective
• Definition of NCCI (CCI), NCD and LCD and their importance
• How NCCI edits impact CPT coding
• ICD-10-CM updates that will affect NCD and LCD
• Helpful tips to send out clean claims
• Learn tools and resources that will help with the up-to-date coding
changes
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3. National Correct Coding Initiative
• National Correct Coding Initiative (NCCI)
• Correct Coding Initiative (CCI)
• Created by CMS to “promote national correct coding methodologies
and to control improper coding leading to inappropriate payments on
Part B claims.”
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4. National Correct Coding Initiative
Purpose of NCCI:
• Prevent providers from reporting two procedures together for which
there is a third separate code that describes the combination of
services
• Require providers to report the complete procedure code instead of
reporting multiple codes that describe parts of the complete
procedure
• Require providers to report only the more extensive version of the
procedure performed
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5. National Correct Coding Initiative
Procedure to Procedure (PTP) edits
• Automated prepayment edits that prevent improper payment
when certain codes are submitted together for Part B covered
services.
• 2 provider type choices:
• Practitioner
• Hospital
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6. Example of PTP Edit
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7. Example of PTP Edit
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8. National Correct Coding Initiative
Medically Unlikely Edits (MUE)
• Maximum number of units of services allowable under most
circumstances for a single HCPCS/CPT code billed by a provider on
a date of service
• 3 provider type choices:
• Practitioner
• Durable Medical Equipment
• Facility Outpatient
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10. Example
Your practice bills CPT® code 11004 with 3 units
Will this claim be paid or denied?
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11. National Correct Coding Initiative
CCI-associated modifiers include:
• Anatomical Modifiers:
• TA-T9
• FA-F9
• E1-E4
• LT and RT
• Global Surgery Package:
• Modifier - 24, 25, 57, 58,
78, 79
• Other Applicable Modifiers:
• Modifier - 27, 59, 91, XE,
XS, XP, XU
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12. National Correct Coding Initiative
Updated Quarterly:
• 1st Quarter: January 1st - March 31st
• 2nd Quarter: April 1st - June 30th
• 3rd Quarter: July 1st - September 30th
• 4th Quarter: October 1st - December 31st
• Make sure your practice is aware of update changes to ensure your
practice has efficient and clean claims submission.
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http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

17. National Correct Coding Initiative
Organized in Two Tables:
• Column 1 / Column 2 Correct Coding Edits
• Mutually Exclusive Code (MEC) Edits
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18. Example
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19. Example
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