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The National Correct Coding Initiative (NCCI) was created to ensure that appropriate payments are made for physician and provider services.
This initiative:
- prevents providers from reporting two procedures that could not have been performed together
- prevents providers from fragmenting one service into component parts and coding each component as if it were a separate service
- requires physicians and providers to report only the more extensive version of the procedures performed disallows reporting of both extensive and limited procedures
Example of Bundled Services
Laboratory Panels: When a serum cholesterol test (82465) is preformed with a laboratory panel (80061), the cholesterol test will be denied as being included in the payment made for the panel (80061).
Sequential Procedures: At times it may be necessary for a provider to perform several procedures in direct succession to achieve the desired result. When this occurs, only the successful procedure should be reported. The unsuccessful procedures will be considered bundled into the successful procedure. A needle biopsy (42400) subsequently followed by an incisional biopsy (42405) would result in Medicare paying only the incisional biopsy.
Standard Preparation & Monitoring Services: Anesthesia procedures generally require certain other services to prepare the patient and to monitor the patient during the anesthesia service. When these services are performed they are considered to be included
in the anesthesia service. Procedure 36000 (introduction of a needle or intracatheter vein) is necessary to prepare the patient for anesthesia and would not be reimbursed separately when done on the same day.
For more information on the National Correct Coding Initiative, visit the Centers for
Medicare & Medicaid website at http://www.cms.hhs.gov/NationalCorrectCodInitEd |
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