What are NCCI Edits?

If you’re still uncertain what a mutually exclusive edit is and whether you’re using the latest NCCI version in your ob-gyn practice, you could be setting yourself up for future reimbursement hassles.

The National Correct Coding Initiative edits are pairs of CPT or HCPCS Level II codes that Medicare (and many private payers) will not reimburse on an individual basis except under exceptional circumstances. Medicare applies the edits to services billed by the same provider for the same beneficiary on the same date of service.

Example: The most recent edition of NCCI (version 12.2), effective July 1, includes an edit bundling therapeutic injection code 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) into 86580 (Skin test; tuberculosis, intradermal). This means that your ob-gyn could not report 90772 and 86580 for the same patient during the same session and expect to receive reimbursement for both procedures.

A great way to avoid issues with NCCI edits is to outsource your medical billing to the professionals who know how to get the highest returns on your services rendered. Outsourcing your medical billing will also free up your staff to help patients and run your practice instead of chasing paper and filing claims.

View all Articles by: Kathryn Etienne, CCS-P