Department for Public Health Division of Administration & Financial Management ITV TRAINING February 2, 2011 NATIONAL CORRECT CODING INITIATIVE (NCCI) Presenter: Janet Overstreet DPH AFM Local Health Operations Branch 1

National Correct Coding Initiative (NCCI) 2

What is NCCI and what is its Purpose? The Center for Medicare and Medicaid (CMS) developed the NCCI to promote national correct coding methodologies and to control improper coding. Medicare has been involved with the NCCI since January 1,

What is NCCI and what is its Purpose? NCCI edits are developed based on coding conventions defined in the American Medical Association’s CPT book, current standards of medical and surgical coding practice, input from specialty societies, and analysis of current coding practice. 4

What are NCCI edits? NCCI edits are pairs of CPT codes that are not separately payable except under certain circumstances. 5

What are NCCI edits? The edits are applied to services billed by the same provider for the same patient on the same date of service. 6

What are NCCI edits? There are two (2) types of edits: Correct Coding Edits: identifies code pairs that should not be billed together because one service is an integral part of the other. For example, vaccine administration code and and evaluation/management visit code when the patient only presented for immunizations. Mutually Exclusive Edits: identifies code pairs that, for clinical reasons, are unlikely to be performed on the same patient on the same day. For example, a mutually exclusive edit might identify two different types of testing that yield equivalent results. 7

How do the NCCI edits apply to Medicaid and Passport? The Patient Protection and Affordable Care Act (PPACA) mandated that state Medicaid programs incorporate compatible methodologies of the National Correct Coding Initiative. 8

What does that mean to LHDs? Combination of a vaccine administration code and an evaluation/management code cannot be reported on the same patient on the same date of service when the patient only receives vaccines. 9

Preventive Medicaid and Passport Discussions with Preventive Medicaid and Passport have resulted in the following: Services billed through the Preventive Fee Schedules will not be exempt from NCCI edits Since administration for vaccines are paid out on the actual vaccine code and the edits may not hit appropriately, DPH is to assure Medicaid that LHDs will not report the vaccine administration with an E/M when the only reason for visit is immunizations. 10

Preventive Medicaid and Passport E/M may be reported in addition to vaccine administration if reported with a “25” modifier and it is a significant, separately identifiable service (a different diagnosis code) Example 1: Patient presents for family planning supplies and also receives a Hepatitis B vaccine Example 2: Patient presents for a TDaP and tells provider she has found a lump in her breast and address complaint at that time The same edits will apply to diagnostic or therapeutic injections (such as: globulins, rhogam, insulin, etc.) 11

Other Health Insurance Plans Several commercial health insurance plans have implemented the NCCI edits or a comparable methodology to ensure correct coding and payments LHDs shall follow the guidance of the NCCI in services reported 12

How to Report Vaccine Administration ? When an immunization is the only service provided or when immunizations are provided along with WIC or another service where a separate E/M may not be reported; the (pseudo E/M) is to be used with reporting the vaccines and administration. 13

How to Report Vaccine Administration ? ICD-9 code V069- may be used to report the vaccines and it should be with the code. If a separate E/M is reported, would not be needed and the V069- would be listed as a secondary ICD-9. 14

Services reported since 1/1/11? DPH has given an effective date of 1/1/11 for LHDs to comply with the National Correct Coding Initiative For vaccines reported with E/Ms where the only reason for visit was for immunizations, LHDs should make all necessary changes in the system and documentation. For payments received for the E/Ms, your agency should assess if there will be a need for refunds. 15

Centers for Medicare and Medicaid weblinks: Centers for Medicare and Medicaid weblinks: #TopOfPage ual/NCCI.pdf 16