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NCCI Changes for The Fourth Quarter Of 2023

NCCI changes 2023

Change is the only constant in the healthcare world. Rapid advancements in technology, evolving treatment protocols, and shifting regulations necessitate continuous adaptation. Healthcare professionals must embrace change to provide the best patient care and stay at the forefront of the industry’s ever-evolving developments. Let’s have a look at the recent NCCI changes for the last quarter of 2023.

The National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits are in place to prevent incorrect payments for services that should not be billed together. Each edit consists of two codes: one in Column One and another in Column Two, both identified by HCPCS/CPT codes. When a healthcare provider submits both codes from an edit pair for the same patient on the same day, Medicare will only reimburse for the Column One code. The Column Two code will only be paid if a clinically appropriate NCCI PTP-associated modifier is also included.

For the fourth quarter of 2023, there are only three minor NCCI changes in code files, effective from October 1. These changes apply to code edits for both practitioners and hospitals. If your healthcare practitioners offer the services affected by these changes, it’s important to be aware of them, as they can have a significant impact on billing and reimbursement.

CMS Updates NCCI Edit Files

In the Practitioner PTP Edit files, you’ll find the following code pairs have revised edits:

Column 1            Column 2

31241                   30802

49614                   49622

49615                   49622

In the Hospital PTP Edit files, you’ll find the following code pairs have revised edits:

Column 1            Column 2

31241                   30802

49614                   49622

49615                   49622

The following is a list of NCCI changes that have occurred.

For the following code pair, the rationale is “Misuse of column two code with column one code.”

31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery

30802 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)

The Change: An edit can now be overridden by a modifier if it is deemed appropriate.

For the following code pairs,

49614 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, Spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or another prosthesis when performed, a total length of the defect(s); less than 3 cm, incarcerated or strangulated.

49615 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, Spigelian), any approach (ie, open, laparoscopic, robotic), recurrent.; 3 cm to 10 cm, reducible

49622 Repair of parastomal hernia, any approach (ie, open, laparoscopic, robotic), initial or recurrent, including implantation of mesh or another prosthesis, when performed; incarcerated or strangulated.

The reason for the NCCI changes is shifting from “mutually exclusive procedures” to “Misuse of column two code with column one code.”

 

NCCI Changes

MEDICODIO to the Rescue

We understand keeping up with these changes regularly can be a tedious task. Coders must regularly update their knowledge due to evolving codes, guidelines, and regulations. This requires dedication and ongoing education to ensure accurate coding, billing, and compliance in the healthcare field.

 At, MediCodio, we have built medical coding software that is powered by artificial intelligence (AI), which will help you stay updated with recent changes in the medical coding space.

MEDICODIO is a promising medical coding automation solution provider dedicated to simplifying medical coding processes. We offer an AI-powered medical coding assistant, CODIO, to healthcare organizations, individual medical coders, and RCM companies. Powered by deep learning and machine learning, CODIO suggests medical codes automatically by reading patient information from EHR systems, physician notes, and charts.

The platform’s wide range of features includes a CPT/ICD code search function, detailed dashboards, NCCI Edit checks, seamless API integrations, and automated data entry. With CODIO, users can accelerate the code selection process, and reduce coding errors, claim denials, turnaround time,  and overcome medical coder shortage issues and expenses in medical coding processes.

We believe in the power of AI and are religiously using it to help people solve their problems.

For more information on NCCI changes: Click Here!

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