Thursday, September 21, 2017

Brief Blog: The National Correct Coding Initiative: Policy Manual: Webinar & Recording on How It Works

CMS maintains a vast public library of edits that govern the (typical) maximum use of CPT codes in units-per-day and that govern what codes can and can't be used together.   In addition there is a multi chapter densely written coding policy manual, the "NCCI Policy Manual for Medicare Services."  This is binding on Medicare, and I understand that the edits were made binding on Medicaid a few years ago.  In addition, the edits and rules may be used by private payers.  Find the NCCI Policy Manual in the links at the bottom of this CMS webpage (here).  The manual is updated annually and published around December.

Today's email brought notice of a webinar by Duane C. Abbey (see here and his company homepage here) on the NCCI Policy Manual.   The Eventbrite registration page is here; scroll down on the page to see a full course description; also copied after the break.  The webinar will be October 12, 2017, and archived on pay-for-video.

A Comprehensive Insight: 

The NCCI Edit Coding Policy Manual Update 2017

Live Webinar | Duane C Abbey | Oct 12, 2017, | 1:00 PM EST | 90 Minutes


Since the early 1990’s CMS has been developing the National Correct Coding Initiative or NCCI. NCCI is a very large set of edits involved CPT and HCPCS codes that are not to be used together. Originally developed for physicians, these edits are nów also used by hospitals for outpatient coding. 

Along with this set of edits, thére is a rather extensive set of coding policies that fôrm the basis for the actual NCCI edits. As CPT and HCPCS are updated, generally expanded, this policy manual is also updated. While additions are easy to find, deletions sometimes go unnoticed. 

Coding and billing staff must be fully conversant with these coding policies in that other third-party payers may also use some, all or even more than what is found with these coding/billing policies. Not only must these coding policies be reàd, the language is sometimes arcane and must be studied with care.
  • Why are the 25 and 59 modifiers so problematic?
  • Are there any differences in use between physicians and hospitals?
  • Why are the coding policies difficult to reád?
  • Do the coding policies ever seem self-contrádictory?
  • How often do these coding/billing policies change?
  • What steps should be taken to stay up-to-date?
  • Whére can I find this NCCI coding/billing policy manual?
  • Is it possible to search this manual?
Objectives of the session:
  • To briefly review the new/changed CPT codes for 2017.
  • To briefly review the new/changed HCPCS codes and modifiers for 2017.
  • To review the proper use of the 25 modifier.
  • To review the proper use of the 59 and related modifiers that circumvent the NCCI edits.
  • To review changes to MUEs (Medical Unlikely Edits).
  • To review the National Correct Coding Initiative coding policies as they relate to modifier utilization.
  • To appreciate the OIG’s finding and compliance concerns for the NCCI edits.
  • To review the new and/or changed general coding/billing policies.
  • To review the new and/or changed specialty coding/billing policies.
  • To appreciate the compliance issues surrounding hospital use of these coding/billing policies.
Agenda of the session:
Overview of NCCI Edits and Coding/Billing Policies
    1. Brief History of the Coding/Billing Policies
    2. Types of Edits
    3. Obtaining the NCCI Coding Policy Manual
    4. Using and searching the NCCI Coding Policy Manual
  1. Overview of Modifiers Used with NCCI Edits
    1. “-59” Modifier
    2. “-25” Modifier
    3. Differences Between Physician and Hospital Utilization
    4. Hospital vs. Physician NCCI Edits
  2. 2017 Updated to CPT/HCPCS
    1. Review of New/Modified CPT Codes
    2. Review of New/Modified HCPCS Codes
    3. Review of New Modifiers
  3. Review of 2017 NCCI Coding Policy Manual Changes
    1. General Guidelines
    2. Specialty Area Guidelines
    3. General Policy Trends
  4. Compliance Issues
    1. Audit Procedures for Proper Use
    2. Recovery Audit Contractor (RAC) Involvement
    3. OIG Concerns
    4. Private Third-Party Payers
  5. Case Studies and Exercises
  6. Sources for Further Information