Billing the Patient for Services Denied Due to NCCI
Services that deny based on NCCI edits may not be billed to Medicare beneficiaries. These denials are based on improper coding rather than medical necessity or a Medicare benefit exclusion. The Advance Beneficiary Notice of Noncoverage (ABN) form cannot be used to seek payment from the beneficiary.
National Correct Coding Initiative Policy Manual
The National Correct Coding Initiative Policy Manual includes policy narratives that describe the principles used to develop edits and also provides examples.
The manual includes the coding policies, as well as 13 narrative chapters. Each chapter corresponds to a separate section of the CPT book; one chapter addresses HCPCS Level II codes and another, the Category III codes. Each chapter is subdivided by subject to allow easier access to a particular code or group of codes.
How to Obtain a National Correct Coding Initiative Policy Manual
The NCCI edits and National Correct Coding Initiative Policy Manual may be downloaded free from the CMS Web site at:
http://cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp#TopofPage
The National Technical Information Service (NTIS) may also be contacted at (800) 363-2068 or (703) 605-6060.
The NCCI edits will be posted as a spreadsheet that will allow users to sort by procedure code and effective date. A “find” feature will allow users to look for a specific code. The edit files are indexed by procedure code ranges for easy navigation. The Web page also includes links to documents that explain the edits: the National Correct Coding Initiative Policy Manual for Part B contractors, Medicare Carriers Manual and the NCCI Question and Answer Page.
