For a very long time, the National Correct Coding Initiative also known as NCCI has been managed and developed by the CMS. A 2017 update of the NCCI edit coding policy manual has been put in place and made available to responsible parties. The NCCI provides a set of edits that stipulate which CPT and HCPCS codes should not be used together when coding. Although the NCCI edits were originally developed for use by physicians, hospitals and other health institutions have adopted them for their coding purposes. It should be known though that these NCCI edits are based on a long and extensive set of coding policies that were put in place also by the NCCI courtesy of the CPT and HCPCS coding rules.Updates to these coding policies often mean that health institutions should comply with the changes. As per experience, finding additions to the coding experience is not challenging, the challenge lies in finding coding policies that have been deleted or changed. Each institution or person that handles billing and coding should be aware of all these changes, this means that they have to have a comprehensive update to the NCCI editing policy update:
- Why are the 25 and 59 modifiers causing major problems?
- What differences exist between physicians and hospitals?
- What makes coding policies and updates difficult to read and understand?
- What above contradicting policies?
- Where can the NCCI coding policy manual be found?
Objectives of the Session:
- To briefly review the CPT coding update for 2017.
- To briefly review the changes in HCPCS codes.
- To review the legal use and application of the 25 and 59 modifiers.
- To give an understanding of the National Correct Coding Initiative coding policies and related updates
- To discuss the OIG’s findings and discuss their compliance concerns for the NCCI edits.
- To review the changes in general coding and billing policies.
- To review the changes in specialty coding and billing policies.
Agenda of the Session :
- Overview of NCCI Edits and Coding/Billing Policies
- Brief History of the Coding/Billing Policies
- Types of Edits
- Obtaining the NCCI Coding Policy Manual
- Using and searching the NCCI Coding Policy Manual
- Overview of Modifiers Used with NCCI Edits
- “-59” Modifier
- “-25” Modifier
- Differences Between Physician and Hospital Utilization
- Hospital vs. Physician NCCI Edits
- 2017 Updated to CPT/HCPCS
- Review of New/Modified CPT Codes
- Review of New/Modified HCPCS Codes
- Review of New Modifiers
- Review of 2017 NCCI Coding Policy Manual Changes
- General Guidelines
- Specialty Area Guidelines
- General Policy Trends
- Compliance Issues
- Audit Procedures for Proper Use
- Recovery Audit Contractor (RAC) Involvement
- OIG Concerns
- Private Third-Party Payers
- Case Studies and Exercises
- Sources for Further Information.
Who should attend?
- Coding and Billing Personnel
- Financial Analysts
- Compliance Officers
- Internal Auditing Staff
- Concerned hospital staff