There are 11,831 new edit pairs, which pushes the total for effective edits to 709,527. There were 346 terminations for a net gain of 11,485. In this release, we find that there are around 350 edit pairs that have termination and/or effective dates retroactive to an earlier period with some going as far back as October, 2001. In fact, all but 10 of the terminated edit pairs are retroactive, adding to the complexity of billing and possible targets for RAC auditors.
If you would like to get a copy of his summary report along with a couple of worksheets that detail these changes, go to www.frankcohengroup.com and click on the Download tab. There is no charge for the analysis or the worksheets.
Free Quikinar on NCCI
Frank will also be conducting a brief (free) Quickinar„¢ to go over the NCCI policies and changes for this release on March 24, 2011 from 11:00 to 11:30. To register, go to his website at www.frankcohengroup.com and click on the Quickinar tab.
If you have any questions, please feel free to contact Frank Cohen.
I have completed my analysis of NCCI version 16.3, including an analysis of the changes from the last quarter release (version 16.2) to the current release. Here are my summary findings:
Currently, for version 16.3, there are 688,013 active edit pairs, meaning that, if the procedure codes listed in column 1 and column 2 were to be billed together by the same physician on the same patient on the same day, it is likely that payment would either be denied or the payment amount would be reduced.
In addition, there are 221,954 terminated edit pairs, which are pairs of codes that at one time were active but under the current version, no longer indicate a restriction of their use as a code pair. For version 6.3, 19,667 new edit pairs have been added to the database while 35 have been terminated, for a net gain of 19,932 new edit pairs. For this version, all have an effective and/or termination date of October 1, 2010 or September 30, 2010.
There were changes to the modifier indicator for 83 edit pairs with 8 going from an indicator of 0 (no modifier allowed) to 1 (modifier allowed) and the remaining 75 going from a modifier indicator of 1 to a modifier indicator of 0.
There are now 1,396 duplicate pairs present in the database, a gain of 20 from version 16.2. Duplicate pairs are edit pairs that were, at one time active, then were terminated and then made active again.
There are also 5,360 swapped edit pairs, which are those that were introduced in one particular order (i.e., column 1 code was 99333 and column 2 code was 92014), terminated and then reintroduced in the opposite order (i.e., column 1 code is now 92014 and column 2 code is now 99333).
I have created a set of worksheets that contain the data associated to this analysis and it is available for immediate download (no charge) at www.frankcohen.com. Click on the Download tab and it should be the second or third link on the page. If you have any questions, feel free to email me at frank@frankcohen.com. Frank Cohen, MPA, MBB at The Frank Cohen Group, LLC.
NOTE: In the MLN Matters announcing the October edits was also this newsflash:
Get your NEW How to Use the National Correct Coding Initiative (NCCI) Tools booklet from the MLN and learn how to navigate the CMS NCCI website. This new MLN product explains how to look up Medicare code pair edits and Medically Unlikely Edits (MUEs). NCCI tools can help providers avoid coding and billing errors and subsequent payment denials. If you want to become familiar with the “National Correct Coding Initiative Policy Manual for Medicare Services” and the tools on the NCCI website, this is your best resource! Click here to download a pdf of the booklet.
A. pairs of services that should not be billed by the same physician for the same patient on the same day.
B. definition refinements for HCPCS codes.
C. diagnosis codes (ICD-9) that cannot be billed together on a CMS 1500 claim.
The answer is below the picture.
Image by sxyblkmn via Flickr
If you answered “A”, you’re on top of your game! The King of the National Correct Coding Initiative (NCCI) quarterly analysis is Mr. Frank Cohen and he provides that analysis free of charge for all. Thank you, Frank! With his analysis, you have the opportunity to see what’s changed and what’s new, to tweak your system to catch the pairs, and to make sure you are providing the right care at the right time as well as maximizing your reimbursement.
The Cohen Report:
In summary, there are 16,843 new edit pairs, bringing the total number of active edit pairs to 653,718. Six of these are backdated to an effective date of January 1, 2010. The majority of these (75.17%) are associated to the edit policy “Misuse of column two code with column one code” with 12.82% associated to “Standard preparation / monitoring services for anesthesia”. There are 6,042 unique Column 1 codes and 274 unique Column 2 Codes within the new edits.
There are 36 new terminated edit pairs with 12 backdated to January 1, 2010 and two backdated to April 1, 2010. The edit policies associated to these edit pairs are distributed between “Misuse of column two code with column one code” (44.4%), “CPT Manual and CMS coding manual instructions” (33.3%) and “More extensive procedure” (22.2%).
There were 413 edit pairs with modifier changes. Of these, 387 went from 0 (no modifier permitted) to 1 (modifier permitted) and 26 went from an indicator of 0 to an indicator of 1.
There are currently 1,336 duplicate entries; codes that were activated at one point then terminated and then re-activated. There are 5,318 swapped edit pairs; situations where the edit pair was introduced at one point in a specific order (column 1 and column 2), terminated and then re-activated with the edit pair in the opposite order.
I have posted my analysis worksheets for those interested in the details. Go to www.frankcohen.com and click on the Download tab.
There are 11,831 new edit pairs, which pushes the total for effective edits to 709,527. There were 346 terminations for a net gain of 11,485. In this release, we find that there are around 350 edit pairs that have termination and/or effective dates retroactive to an earlier period with some going as far back as October, 2001. In fact, all but 10 of the terminated edit pairs are retroactive, adding to the complexity of billing and possible targets for RAC auditors.
