Understanding of NCCI Commercial Insurance and Coding

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JoAnne: Q: Can you speak on the relevance of NCCI, commercial insurance and coding encounters? Example, if the patient is not on Medicare, do NCCI codes matter?

A: The acronym NCCI means National Correct Coding Initiative. It was developed by Medicare for Medicare, but I can tell you from firsthand experience that some insurances follow the Medicare Correct Coding Initiative, but a lot of insurances don’t. What you need to do is go to insurance company’swebsite andthey will allow you to keep punching procedure codes and they will give you the edit and even make recommendations for the modifiers, but in the provider manual under reimbursements, they will also indicate if they follow the Medicare Correct Coding Initiative. Blue Cross, Blue Shield absolutely has their own… and this has been going on for years.

Understanding of NCCI Commercial Insurance and Coding – Video

The point I’m making is you really have to play with it with your own payers in your practicebecause you can bill, let’s say an office visit and urinalysis with Medicare and get paid. Then, ifyou bill Blue Shield, they’ll bundle the urinalysis into the office [visit.] That’s a very simpleexample. I mean, talking about surgeries and such as Tammy just said makes a big difference. Medicare and a lot of the commercial carriers are on two different pages; so you really have to be proactive and see how the insurances pay, and on the EOB sometimes, it will tell you if theyfollow the Medicare guidelines.

Alicia: I was going to mention too that I worked in billing short time, nothing like JoAnne, and I think – correct me if I’m wrong JoAnne – you can’t be afraid to have that contact with the payer. They have a contact number and you need to be on the phone every time that you come up against something that you don’t understand. Reach out to them and that’s how you become knowledgeable and they’re all different, aren’t they? They all have their own little nuances that they’re like.

JoAnne: Yeah.