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We will discuss the NCCI Edit manual. We will review the entity responsible for creating and maintaining the manual and what entities use the NCCI manual. We will define the edits and the methodology behind the edits. We will discuss the history of the edits, when it was created and when it gets updated. We will go over how to locate the edits for Medicare, Medicaid, and Commercial payers. We will discuss why these edits exist and how to use them. We will review some specific examples of using the NCCI edits.

Learning Objectives:

• To review the overall development of the NCCI edits
• To have knowledge of the NCCI edit coding policy manual
• To carefully review the definition of the modifier
• To 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
• To review the general and specific policies inherent in the NCCI guidelines
• To identify the differences in coding policies between physicians and hospitals
• To appreciate the compliance issues surrounding physician and hospital use of the modifier 55 and 59 modifier
• To 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 policies

Areas Covered in the Session

• Who: creates, maintains, uses
• What: edit, methodology
• When: history of, created, updated
• Where: locating
• Why: do these edits exist
• How: using the edits

Suggested Attendees

• Coders
• Revenue Cycle staff and managers
• Auditors
• Compliance Officers
• Billers/ Revenue Cycle Managers
• Consultants
• Physicians
• Nurses
• Claim Officers
• Healthcare administrators and providers

About the Presenter