NCCI Edits

sghany

Can someone please share how they handle charges when the NCCI edit will not allow billing a certain service performed on the same day? My thought is that irregardless of the type of edit (PTP, MUE), charge(s) will always stay on the account and manually corrected on the claim. What are your thoughts?  Do we keep the charge(s) and do not bill for the service?

SLH2501

The practice for the company I work for is that if the service was charged correctly but just not allowed due to the NCCI edit, then we leave the charge on the account but manually remove it from the claim. 

dwilliamsrsi

You want to be sure that you capture all of the resources/cost involved in a procedure even if multiple codes are not separately reportable.  So, if there is a separate charge for the second procedure (the one for which a code should not be reported) and this charge is not represented in the charge for the code being reported, then you would want to combine the charges to insure that you report all of your cost.  The danger of just stripping off a line item is that you under-report the resources and cost that is required for the combination of services.   If this happens a lot, you can consider creating a single CDM line item for the combined service and then the cost/charge will be fully representative of the service. 

kolljr

Every organization handles these edits differently. One thought is to use an adjustment code to write off the charges before the claim bills. This way the performing department keeps their gross revenue which was most likely budgeted for. Another way is to roll the price of the adjusted code into the main procedure , and then just charge for the main procedure.