NCCI Policy Manual Updated

The National Correct Coding Initiative Policy Manual contains an important update in Chapter 1, General Correct Coding Policies.  The updated manual was effective January 1, 2013.  This chapter describes proper coding principles, modifier issues, medical and surgical packages, and other coding policies.

Section D – Evaluation and Management (E&M) Services summarizes the rules associated with billing E& M services with procedures included under the Medicare Global Surgery rules.  Additional language was added to the minor surgery discussion.  The following sentence was added to the text.  “E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure.”  It continues on with the following text that has previously been included in this manual.  “The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.”

Modifier 25 usage has been, and continues to be, highly scrutinized by third party payers and the Office of Inspector General.  This revision re-emphasizes that office visits on the same day as a minor procedure are most often included in the payment for the minor procedure – and not separately reimbursed.

Additional information on the National Correct Coding Initiative and the manual update can be found at:  http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

For additional information on this issue, contact us for our Modifier 25 FAQ or distance learning module.