NCCI Edits and Hidden Medicare Coding Guidance

Event Information
Product Format
Prerecorded Event
90 Minutes
Product Description

Make Use of Medicare NCCI Edits and Coding Policies to Get Maximum Reimbursement

The NCCI edits have been developed over the last two decades. While the NCCI edits are globally recognized, the coding policy manual that comes with the NCCI edits is not as well known. The coding policies associated with the NCCI edits basically started out as an explanation of why certain edits were established. While these edits have been developed for physicians, when the OPPS was implemented in 2000, most of the edits and the policies were also extended to hospitals.  Given that the coding for physician services versus hospital services can be different, the proper application of these coding policies becomes confusing.

Expert speaker Dr Duane Abbey would be discussing the following questions in this 90-minute session:

  • What are these NCCI edits?
  • How many edits are there?
  • Did the NCCI edits engender the development of the “-59” modifier?
  • Where did the coding policies come from?
  • What if the NCCI coding policies don’t conform to other coding guidance?
  • Where can I get the coding policy manual?
  • Do the coding policies include consideration for proper modifier utilization?
  • Are the MUEs (Medically Unlikely Edits) included in this policy manual?
  • Why is this area so confusing?
  • Should we base our coding and billing policies and procedures on the NCCI policy guidance?
  • What kind of differences are there between physician and hospital coding policies from NCCI?

Session Objectives:

  • Review the overall development of the NCCI edits.
  • To have knowledge of the NCCI edit coding policy manual.
  • Carefully review the definition of the “-59” modifier.
  • Review the operational use of the National Correct Coding Initiative edits.
  • To appreciate how physicians and hospital should use modifiers in connection with the NCCI edits.
  • Review the general and specific policies inherent in the NCCI guidelines.
  • Identify the differences in coding policies between physicians and hospitals.
  • To appreciate the compliance issues surrounding physician and hospital use of the “-59” modifier.
  • Review policies relative to specific service areas as delineated in CPT
  • To appreciate possible RAC and other audit activities in conjunction with the NCCI coding polices.

Session Agenda:

  • Overview of NCCI edits
    • Number of edits
    • Types of edits
    • Inherent coding guidelines
    • Hospital vs. physician NCCI edits
    • Using the “-59” Modifier to avoid edits
    • Absolute bundling versus relative bundling
  • NCCI coding guidance
    • Overview of NCCI coding policy manual
    • Fundamental general NCCI coding principles
    • Specific examples of guidelines
      • General
      • Dermatology
      • Endoscopic procedures
      • Surgical procedures
      • E/M coding
      • Medical procedures
    • Relationship of NCCI coding principles and Medicare rules and regulations
    • Relationship of NCCI coding principles with private payers
  • The use of Modifiers with the NCCI policies
    • Definitions and descriptions in CPT/HCPCS
    • Utilization of key Modifiers for circumventing the NCCI edits
    • Provider coding, billing policies and procedures
    • Editing software
  • Compliance issues
    • OIG studies
    • Audit procedures for proper use
    • Recovery audit contractor involvement
  • Sources for further information

Who should attend: Coding Personnel, Billing and Claims Transaction Personnel, Chargemaster Coordinators, Financial Analysts, Compliance Personnel, Physicians, Internal Auditing Staff and Other Interested Personnel

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
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