National Correct Coding Initiative

 

Effective on or after October 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will implement the National Correct Coding initiative (NCCI) Procedure to Procedure (PTP) edits for Durable Medical Equipment (DME).  This will affect services related to wheelchair bases (WCB), wheelchair options and accessories (WCOA), and wheelchair seating (WSC).

 

The Centers for Medicare and Medicaid Services (CMS) developed the NCCI to promote national correct coding methodologies and to control improper coding leading to inappropriate payment.  CMS utilized various resources to determine the policies which includes coding conventions defined in the American Medical Associations Healthcare Common Procedure Coding System (HCPCS) manual, national and local policies, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices.

 

NCCI (PTP) Edits define pairs of HCPCS codes that should not be reported together for a variety of reasons.  These edits consist of column one codes and column two codes.  If both codes are reported, the column one code is eligible for payment and the column two code is denied.  In some instances, an appropriate modifier may be added to one or both codes of an edit pair to make the code combination eligible for payment.  For more information, please refer to the CMS website at www.cms.gov.

 

NCCI does not include all possible combinations of correct coding edits or types of unbundling.  Providers are obligated to code correctly, even if edits do not exist to prevent the use of inappropriate code combinations.

 

SCDHHS continues to contract with Health Management Systems Inc. (HMS) to perform NCCI edit reviews for services filed on a CMS-1500/837P and services reimbursed on an UB-04/837I.  

 

The following edit will continue to be used for NCCI:

 

          Edit 591 – NCCI – Procedure Code Combination Not Allowed

 

Services denied based on NCCI code pair edits may not be billed to the patient.  Some DME services require a prior authorization (PA). Please refer to the DME manual for a listing of codes requiring a PA.  Having a PA is not a guarantee of payment; the provider remains responsible for reviewing all claims for possible PTPs and Medically Unlikely Edits (MUEs) coding issues.

 

Please contact the Provider Service Center at 1-888-289-0709 if you have questions regarding this bulletin.  Thank you for your continued support and participation in the South Carolina Healthy Connections Medicaid Program.

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