Description:

The National Correct Coding Initiative, implemented in 1996, was Developed to Promote national correct coding methodologies and Control improper coding for appropriate reimbursement Based on coding guidelines from CPT, Specialty Societies, Standard medical and surgical practices, National local policies edits, and Current coding practices.

The Medicare National Correct Coding Initiative (NCCI) (CCI) was implemented to promote national correct coding methodologies and control improper coding leading to inappropriate payment. NCCI Procedure-to-Procedure (PTP) code pair edits are automated prepayment edits that prevent improper payment when specific codes are submitted together for covered services.

The NCCI Procedure to Procedure (PTP) edits aim to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits for physicians or practitioners and one for outpatient hospital services. The purpose of the NCCI Medically Unlikely Edits (MUE) program is to prevent improper payments when benefits are reported with incorrect service units.

In this one-hour session, we will thoroughly explore these files to see what information they contain. These files are not only used for billing and coding but also for processing insurance claims and understanding why some claims are denied. Many denials happen because a claim doesn't meet the requirements in these files, indicating errors in the claim.

These files have different sections, so it's crucial to understand each part and know which ones apply to a specific claim. Sometimes, you may need to change a claim by using modifiers, codes, and so on. Figuring out how to correctly code services or procedures and whether they are considered a package or separate can be challenging. Fortunately, CMS provides these guidelines for free on their website (cms.gov) for anyone to access.

The NCCI Three Essential Edit Parts:

• PTP (Column 1/Column 2)
• Medically Unlikely Edits (MUE)
• Add-on Code Edits

 The Relative Value File contains important file types:

• LOCCO- Locality files
• ANES- Anesthesia
• GPCI-Geographic Practice Cost Indices
• OPPSCAP- Outpatient Prospective Payment System
• PPRRVU- Physician Productivity Rates Relative Value File

Areas Covered:

• National Correct Coding Initiative (NCCI)
• Procedure to Procedure Edits
• Medically Unlikely Edits
• Policy Manual
• Relative Value File
• CPT/HCPCS Cod status
• RVU Values
• Post-operative period
• Assistant at Surgery
• Supervision for diagnostic testing
• Bilateral procedures

Session Highlights: 

• Recognize the coding edits created by the Center for Medicare and Medicaid Services (CMS)
• Understand how insurance companies use the National Correct Coding Initiative (NCCI) to process claims.
• Apply the policies and guidelines in the NCCI Policy Manual for clean claims.
• Determine what to apply to your coding and billing from the relative value file.
• Create custom files with coding information for your practice
• Defend coding by using the NCCI and Relative Value File for appeals on denied claims
• Realize the Medically Unlikely Edits(MUE) for quantity billing and know there are two parts.

Why Should You Attend:

The National Correct Coding Initiative (NCCI) and the Relative Value File are two database files created by the Center for Medicare and Medicaid Services (CMS) for correct coding rules and guidelines related to Medicare claims. There are several different parts of these files, so it is essential to understand each piece to know which ones should be applied to a particular claim and if there is a need to alter a claim utilizing modifiers, codes, etc. Both the NCCI and Relative Value File give guidance for Medicare claims.

Who Should Attend:

• Billers
• Coders
• Administrators
• Collector
• Supervisors
• Claims adjusters
• Reimbursement Specialist

Presenter Information:

Name: Lynn M. Anderanin

Lynn Anderanin, CPC, CPB, CPPM, CPMA, CPC-I, COSC, has over 40 years of experience in all areas of the physician practice, specializing in Orthopaedics For AAPC Lynn is currently a VILT Instructor, Workshop, and Audio Presenter. She is the founder of her Local Chapter and a former member of the NAB.

She is the Sr. Director of Coding Compliance and Education for Healthcare Information Services, a physician billing and consulting service in the Chicagoland, area. She has over 30 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopedics, Rheumatology, and Hematology/Oncology.