How can I see which HCPCS/CPT codes should not be reported together as per NCCI edits?
The list of NCCI edits has these six columns.
- Column 1 indicates the payable code.
- Column 2 contains the code that is not payable with this particular Column 1 code unless a modifier is permitted and submitted.
- Column 3 indicates if the edit was in existence prior to 1996.
- Column 4 indicates the effective date of the edit.
- Column 5 indicates the deletion date of the edit (if applicable).
- Column 6 indicates if use of a modifier is permitted.
The number in column six will either be 0, 1, or 9. The number “0” in column 6 means there are no modifiers allowed to bypass the edit (i.e. there are no circumstances in which both procedures should be paid for the same patient on the same day by the same provider). The number “1” in column 6 means a modifier is allowed to bypass the NCCI edit and permit reimbursement for the column 2 code. The number 9 means that an NCCI edit does not apply to this code pair; the edit for this code pair was deleted retroactively. For further explanation, click here.