Time for Third Quarter NCCI Edits!

Mon, Jun 20, 2016 --

Coding Updates

3rd Quarter NCCI Update, q3 cci update, medicare, MUE, PTP

July 1 is approaching fast, which means it’s time for the third quarter updates to the National Correct Coding Initiative (NCCI) Edits. Version 22.2 of the NCCI edits take effect on July 1, 2016. You can download the July hospital and practitioner procedure to procedure (PTP) files at the CMS site here. You can grab the latest medically unlikely edits (MUEs) at the CMS site as well, here. SuperCoder’s CCI Edits Checker will feature all the new CCI and MUE information by July 1.

Check Out This Orthopedic July 1 CCI Highlight

One big change that could make orthopedic practices — and their coders — very happy is the edit reversal to 29823.

Here’s the deal. Previously when you reported 29823 (Arthroscopy, shoulder, surgical; debridement, extensive), 29823 was bundled into the three codes listed in bullets below, meaning you could get paid only for the following:

  • 29824, … distal claviculectomy including distal articular surface (Mumford procedure)
  • 29827, … with rotator cuff repair
  • 29828, … biceps tenodesis.

However, when July 1 rolls around, you’ll be able to report the above code combinations (i.e., 29824/29823, 29826/ 29823, 29828/29823) and receive reimbursement for both codes. Make sure your surgeon’s documentation clearly describes the debridement as extensive, or you will risk the payer’s downcoding to 29822 (… debridement, limited) and denying the claim.

NCCI — Isn’t That a TV Show About Solving Crimes?

Healthcare in general, and medical coding in specific, possess an ever-expanding collection of abbreviations, and NCCI and CCI are among them. HHS implemented the Medicare National Correct Coding Initiative (NCCI, also known as CCI) to control improper coding that can lead to inappropriate payment. NCCI edits are a list of CPT® or HCPCS Level II codes that are not separately payable, except under certain “unbundling” circumstances, when performed with certain procedures. There are two types of NCCI edits: medically unlikely edits and bundled edits. Medically unlikely edits (MUEs) are a number. For example, imagine that 69209 has MUE 2. That means if you report 3 units of 69209, you’ll get a denial because 2 is the maximum number of units that CMS expects to see reported for that code. With bundled edits, NCCI considers the component code service to be included in the comprehensive code, so the component code is not separately billable.

CMS publishes a new NCCI Coding Policy Manual every January 1. Edit updates roll out each quarter, on January 1, April 1, July 1, and October 1.

How About You?

How does your practice manage the quarterly updates? In my (admittedly biased) opinion, the easiest, most efficient way is to simply be a subscriber to a SuperCoder product such as Fast Coder (see below), but maybe you have another way. Let us know, please, in the comment box below.

Ease Your CCI Edits Hassles With Fast Coder!

Fast Coder makes your CCI edits checking chores so much simpler — no more squinting at CMS’s minimalist spreadsheet! Fast Coder shows allowed, unallowed, and modifier allowed codes in bold, intuitive colors. And, you can check all edit combinations of up to 25 codes with a single click! Fast Coder also gives you complete code lookups for CPT®, HCPCS, and ICD-10-CM showing not only the code and its official descriptor, but also Relative Value Units (RVUs) and lay terms, too! Fast Coder has so much to offer. Check it out!

About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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4 Comments For This Post

  1. Sam Says:

    So has there been any word on the manual being updated for the shoulder codes? Despite the edit being lifted, the manual still clearly states that “With the exception of the knee joint, arthroscopic debridement should not be reported separately with a surgical arthroscopy procedure when performed on the same joint at the same patient encounter.”

  2. Deborah Marsh Says:

    Great point. Per AAOS, the CMS policy had allowed the agency to deny payments when these procedures are performed or billed together. Specifically, their edits have denied 29823 for extensive arthroscopic shoulder debridement with the other arthroscopic shoulder procedures discussed in the post, such as 29827 for arthroscopic rotator cuff repair or 29824 for arthroscopic distal claviculectomy.

    AAOS has indicated that their discussions with CMS on the removal of these edits included updating the policy manual, with deletions effective in the July 1, 2016 version of CCI (www.pwrnewmedia.com/2016/aaos/advocacy_now/apr12/pages/article1.html). This should allow coders to report the debridement code along with the other listed arthroscopy codes, and we expect to see the CCI manual wording change in the next update as well. Some consultants are suggesting that you verify with your MAC that reporting the codes together is allowed, just to be safe.

  3. Sam Says:

    The information I received from Karen Zupko states that the guidelines are only updated annually unlike the PTP edits.

    “Remember, CMS’s NCCI system has two parts: procedure-to-procedure (PTP) edits and narrative guidelines. The procedure-to-procedure edits were developed first and are updated quarterly. The narrative guidelines are only updated annually, in January, and are designed to apply to multiple code combinations. Changes to a PTP edit do not automatically revise a narrative guideline, thus both factors must be considered when coding.

    A 2016 NCCI narrative guideline found in Chapter IV, Section E, Paragraph 6 states: “With the exception of knee arthroscopy, (29877, 29874, G0289) debridement should not be reported with another surgical arthroscopy procedure, same joint, same encounter.” As long as this narrative guideline is present, it is not appropriate to report 29823 for debridement in the same shoulder when 29827, 29824, or 29828 are performed, even if there is no PTP edit between the codes.

    NCCI has reportedly not provided AAOS representatives with any information other than that the edits will be deleted effective July 1.

    What is KZA’s advice? For non-Medicare plans, report 29823 when it is appropriately documented, even when it is performed in the same shoulder as these other procedures. That’s because the AAOS has always classified debridement as a separately reportable procedure under its Global Service Data guidelines.

    For Medicare plans, until NCCI issues clarification or formally removes this narrative guideline, we must assume it still applies. If you receive alternate instruction from your Medicare MAC, report it to KZA, and we’ll share that information with our orthopaedic community.

  4. Deborah Marsh Says:

    Hi – The 2017 CCI manual has been posted and addresses these codes. Here’s an update: http://blog.supercoder.com/coding-updates/cci-2017-manual-provides-shoulder-arthroscopy-answers-youve-been-waiting-for/

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