A major error with two of the finalized National Correct Coding Initiative (NCCI) edits published for the new device monitoring services effective January 1, 2009 (Version 15.0 ) was discovered and immediately brought to the attention of the Centers of Medicare and Medicaid Services (CMS) by the Heart Rhythm Society and the American College of Cardiology. Version 15.0 edits currently prohibit billing the technical component (93296) with the professional component for a 90-day remote interrogation evaluation of a single, dual or multiple lead pacemaker (93294) or ICD (93295) system on the same date of service.
NCCI edits are updated four times a year, with each subsequent version replacing its immediate predecessor. CMS has stated that it will delete these two code pair edits in Version 15.1, the next quarterly update scheduled for implementation on April 1, 2009. The deletion will be retroactive to the January 1 implementation date.
The NCCI was developed by CMS to prevent inappropriate payment of services that should not be billed by the same physician for the same patient on the same date of service. NCCI edits are used by Medicare carriers in adjudicating claims and are also utilized by many commercial payers and Medicaid agencies. The NCCI edits consist of two tables: “Column One/Column Two Correct Coding Edit Table” and “Mutually Exclusive Edit Table”. Each edit table contains edits which are pairs of HCPCS/CPT codes that in general should not be reported together. Each edit has a Column one and Column two HCPCS/CPT code. When a provider reports both codes of an edit pair, the Column two code is denied, and the Column one code is eligible for payment.
Under certain circumstances, it is appropriate to utilize an NCCI-associated modifier, which would allow separate payment for both Column one and Column two codes. Each NCCI code pair edit is designated with a modifier indicator “0”, “1” or “9”. The “0” modifier indicator appended to a code pair means that under no circumstances may a modifier be used to bypass that edit. Conversely, a “1” modifier indicator appended to a code pair indicates that an appropriate NCCI-associated modifier may be used to override the edit. Finally a “9” modifier indicator denotes that the code pair’s deletion date is the same as its effective date meaning that the particular edit was deleted before ever becoming effective.
Version 15.0 edits prevent billing the technical component and professional component of a 90-day remote interrogation evaluation of a single, dual or multiple lead pacemaker or ICD system on the same date of service by bundling 93296 into 93294 and 93295. Both edit code pairs are assigned a modifier indicator of “0” to signify that NCCI-associated modifiers cannot be used to override the edit. A modifier indicator of “0” also establishes that you should only report the service in Column One. With these code pair edits in place, currently there is no way to receive payment for technical assistance. CMS further stated that providers may choose to delay submitting claims for both of these code pairs until April 1, 2009. If providers have claims denied based on these edits prior to April 1, 2009, they may resubmit or appeal their claims after April 1, 2009.
To learn more about NCCI edits, visit CMS’ web site
