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