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Understanding NCCI Edits and Bundles – Review of Ophthalmology

For proper reimbursement, it’s necessary to know which codes cannot be submitted together and how to use modifier -59.

This article answers the following questions:

  • What is the National Correct Coding Initiative?
  • What are NCCI “edits” and how do they affect reimbursement?
  • How should we interpret the NCCI table, Column 1 and Column 2, on the CMS website?
  • What happened to the Mutually Exclusive edits file previously posted as part of the NCCI edit file?
  • Is there a way to override the edit and permit payment of both procedures?
  • When is it appropriate to break an NCCI edit with modifier -59?
  • Are there any other edits that affect Medicare reimbursement?
  • Are Medicare Unlikely Edits new?
  • Is the MUE table on the CMS website and now should we interpret it in the context of DOS MUEs?
  • How often are these edits updated and/or revised?

This article was published in Review of Ophthalmology’s Medicare Q & A column, which is written by Corcoran’s Vice-President, Donna McCune, CCS-P, COE, CPMA. To view the entire article in Review of Ophthalmology, click on the link below:

See page 16.

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