TMA Explains Medicare/Medicaid Coding

TMA's Payment Advocacy staff have prepared a free presentation to refresh physicians' understanding of how the Medicare National Correct Coding Edits (NCCI) process works. It explains the importance of billing according to the NCCI edits, includes tips for ensuring that your practice stays current with NCCI changes, outlines the differences among the Medicare, Medicaid, and commercial edits, and provides other helpful billing tips.

The Centers for Medicare & Medicaid Services requires all Medicare claims to be processed against the NCCI to promote accurate coding. The health system reform law required Medicaid to implement the NCCI edits, as well. Texas Medicaid did so last fall. All Medicaid claims submitted on or after Oct. 1, 2010, are subject to 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.  

Action, June 1, 2011