The latest National Correct Coding Initiative (NCCI) edits, Version 18.2, is effective July 1 and available through the Centers for Medicare & Medicaid Services (CMS) Data Center. The Recurring Update Notification applies to Medicare Claims Processing Manual, chapter 23, section 20.9. You can look forward to the release of a test file around May 2. A final file will be available around May 17.
Version 18.2 includes previous versions and updates from Jan. 1, 1996 to now, and is organized in two tables:
- Column 1/Column 2 Correct Coding Edits
- Mutually Exclusive Code (MEC) Edits
The coding policies are based on coding conventions defined in the:
- American Medical Association’s (AMA’s) CPT® manual
- National and local policies and edits
- Coding guidelines developed by national societies
- Analysis of standard medical and surgical practice
- Review of current coding practice
See MLN Matters® article MM7802 for more information. EdgeBlast or Coding Edge will keep you abreast on the updates when the final document is released.
April 12th, 2012
A study presented at Digestive Disease Week in Chicago last year suggests that physicians may be deliberately performing endoscopies on different days to avoid bundling—and the attendant reduction of payment—by Medicare payers, reports Internal Medicine News.
Researchers identified 12,905 Medicare beneficiaries who underwent both a colonoscopy and diagnostic upper endoscopy procedure within 180 days of each other. Nearly two-thirds of all procedures were bundled; the remaining procedures (approximately 37 percent) were separated from each other by a median of just 26 days, and approximately 30 percent of procedures not performed on the same day were separated by four or fewer days.
“The lack of bundling was unlikely to be explained by clinical necessity,” commented lead investigator Dr. Hashem B. El-Serag. Rather, El-Serag believes physicians making clinical choices may have been influenced by purely financial concerns.
Providing related endoscopic services on the same day is more convenient, efficient, and cost-effective, but there is a financial disincentive for physicians to embrace this approach. Medicare pays less when two endoscopic procedures are reported for the same patient on the same day. For example, reimbursement for a diagnostic upper endoscopy is approximately $75 when bundled; the payment nearly doubles ($150) if the procedure is reported independently.
The study stopped short of making recommendations to prevent such unbundling of endoscopic services, but lead researcher El-Serag did caution, “The financial implications to the health care system and the increased adverse events in patients are likely to be large.”
December 30th, 2011
The Centers for Medicare & Medicaid Services (CMS) has released the 2012 Medicare Physician Fee Schedule (MPFS) rates final rule. The payment rate adjustment is effective for services delivered on or after January 1, 2012. As you will note, the announced rate reflects a 27.4 percent SGR downward adjustment. This downward adjustment is slightly less than the 29.5 percent reduction previously projected by CMS. Unless Congress intervenes to prevent this cut from taking place, physicians will experience a dramatic reduction in their Medicare fee schedule payments.
November 2nd, 2011
The annual updated version of the National Correct Coding Initiative (NCCI) policy manual for Medicare services will be effective Jan. 1, 2012, rather than Oct. 1, 2011. This manual will be posted on the NCCI website on or around Dec. 1, 2011.
CMS posts changes to each of its NCCI and Medically Unlikely Edit (MUE) edit files on a quarterly basis. Download a test file of Version 18.0, effective Jan. 1, 2012, from the National Correct Coding Initiative Edits Quarterly NCCI and MEU Version Update Changes page on the Centers for Medicare & Medicaid Services (CMS) website. The final file will be available “on or about” Nov. 17, according to CMS Transmittal 2322.
Visit the National Correct Coding Initiative Edits Overview page on the CMS website for more information about NCCI.
October 28th, 2011
The National Correct Coding Initiative (NCCI) version update to 17.3 will be implemented by Medicare administrator contractors (MACs) on Oct. 1, 2011. Like previous updates, the new file outlining the unbundling standards used by the Centers for Medicare & Medicaid Services (CMS) and several commercial payers includes hundreds of changes based on utilization data and updated national and local guidelines and decisions.
August 11th, 2011