TMA Explains New Medicaid Coding Edits

On Feb. 25, as required by the health system reform law, Medicaid implemented the National Correct Coding Initiative (NCCI) edits.

The edits tell you when two procedures can be reported together and when they cannot. For example, cutting through lesions during surgery is part of the surgery and not a separate payable service. The edits are not the same as those in Medicare, partly because of differences in the Medicaid program's patient populations and partly because of Texas Health and Human Services Commission policy decisions.  

TMA's Payment Advocacy staff is preparing a free presentation to help physicians understand the implementation of the Medicaid NCCI edits. The presentation also covers Medicare NCCI edits, the differences between the Medicare and Medicaid edits, commercial edits, and other helpful billing tips.

When completed, the presentation will be posted on the Medicaid page of the TMA website.


Action, April 15, 2011


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