NCCI Edit Change

The American Society of Cataract and Refractive Surgeons (ASCRS) and the American Academy of Ophthalmology (AAO) report that the Centers for Medicare and Medicaid Services plan to suspend the NCCI edits implemented on July 1, 2013, affecting services provided within the global surgery period. The numerous denials resulted from a computer issue at the Medicare Administrative Contractors’ (MACs) offices. Modifiers 24, 25, and 57 were supposed to “override” the NCCI edit and permit payment of claims. Most systems denied claims with these modifiers, forcing practices to file an appeal for payment.

The NCCI edit change will be implemented October 1, 2013, retroactive to July 1, 2013. Some MACs are processing claims appropriately with a temporary fix to their systems. If this is the case, you may continue to file claims and resubmit claims previously denied. If no fix exists with your MAC, you should consider holding office visits for these claims until after October 1, 2013. Check with your MAC for further instructions on denied claims and reprocessing.

In the meantime, recognize that this is a temporary change. CMS intends to put these edits back into place once this computer issue is resolved. This is a great opportunity to revisit the global surgery rules and determine if an office visit is supported by your documentation. Corcoran Consulting Group publishes many tools to assist practices better appreciate these rules. Visit our website for more information on how to apply these modifiers correctly.

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