Cracking the Code

National Correct Coding Initiative (NCCI) Edit

As a medical coder, it is important to ensure claims are accurate as possible on the front end before finalizing and sending them off to the billing department. With outpatient medical coding, coders are responsible for clearing all edits before completing medical accounts. National Correct Coding Initiative (NCCI) edits are very common. HCPCS codes are arranged in Column 1 and Column 2. Column 1 indicates the payable code. Column 2 indicates the code that is not payable with a particular Column 1 code unless a modifier is permitted and submitted. Pay very close attention to what the edit requests to ensure it is cleared and submitted properly.

Even if the provider’s documentation supports both CPT procedures, it is inaccurate to report both in this example. Since the NCCI edit clearly states that CPT 80306 cannot be reported even with the use of a modifier, it is appropriate to only report CPT 80307.

Q: NCCI Edit: Code 80306 is identified as part of another procedure on the claim, code 80307, coded on the same day, where the use of a modifier is not appropriate. Only code 80306 of the code pair is rejected; code 80307 is allowed.
A: CPT 80307
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