How frequently are National Correct Coding Initiative (NCCI) edits updated?
C. quarterly
The objective of the medically unlikely edit (MUE) is to provide a mechanism to report
D. medically reasonable and necessary units of services for designated CPT procedure codes performed on the same date of service.
An example of an acceptable National Correct Coding Initiative (NCCI) modifier is
C. modifier -91.
Modifier -91 is the only acceptable modifier. By definition, the -91 modifier is used to indicate a repeat laboratory procedural service on the same day to obtain subsequent reportable test values.
CPT procedures 77334 and 77336 indicate the following edit: "modifier required for component/comprehensive code." What modifier would be required on CPT procedure code 77336 to satisfy the NCCI edit?
B. -59
The primary purpose of the NCCI edit on modifier -59 is associated with two or more procedures that are performed at different anatomic sites or different patient encounters.
Which modifier is an example of an acceptable National Correct Coding Initiative (NCCI) modifier to describe the CPT procedure code pairing 94640-94644?
A. -76
Per CPT procedure parenthetical notes, -76 is required for more than one inhalation treatment performed on the same day.
Which modifier is an example of an acceptable National Correct Coding Initiative (NCCI) modifier to describe the CPT procedure code pairing in the example below?
A. 83036, 83036-91
Per NCCI, -91 is appended to CPT procedure code 83036 at the line charge to report that repeat laboratory tests were performed on the same date.
Which modifier is used to describe two portable chest X-rays read by the same physician on the same day?
A. -76
Modifier -76 is applied to the CPT procedure code when the same physician interprets the radiology results on the same patient, on the same day.
Which modifier is an example of an acceptable National Correct Coding Initiative (NCCI) modifier to describe a reference laboratory CPT code modifier?
A. -90
Modifier -90 is applied to the CPT procedure code when the ordering facility submits the laboratory specimen to an independent clinical laboratory for testing.
An example of a National Correct Coding Initiative (NCCI) edit is
D. comprehensive/component is not separately payable.
A National Correct Coding Initiative (NCCI) rejection code on a line item CPT procedure code would best be described under which of the following circumstances?
C. Mutually exclusive procedure codes that are not allowed even if an appropriate modifier is present.
In this example, the OCE editor has addressed the NCCI "Mutually Exclusive edit tables" as a subset of the OCE software. In this example, diagnosis, to and from date, and the number of edits on the present claim are not NCCI edits, but are part of the OCE software.
What does Column 1 represent regarding the NCCI Column 1/Column 2 mutually exclusive edits on the edit table?
D. The column 1 code represents the procedure with the lower relative value unit (RVU).
When represented on the mutually exclusive NCCI edit table, the column 1 CPT code generally denotes the procedure or service with the lower work RVU (relative value unit) and is the payable CPT procedure or service when reported with the column 2 code.
Which modifier is an acceptable National Correct Coding Initiative (NCCI) modifier to describe the CPT procedure code pairing 96413, 96372?
B. 96413, 96372-59
Which modifier is an example of an acceptable National Correct Coding Initiative (NCCI) modifier to describe a significant evaluation and management by the same physician to the same patient on the same day as another procedure or service?
D. -25
To append -25 appropriately to an evaluation and management code, the services provided must meet the definition of "significant, separately identifiable evaluation and management service" as defined by CPT.
What does Column 1 represent regarding the NCCI Column 1/Column 2 edits on the edit table?
A. The Column 1 code represents the comprehensive CPT procedure code in the code pairing.
CPT procedures 78608 and A4691 indicate the following edit: "procedure combination not separately payable." What is the intent of the NCCI edit regarding the provider's action?
D. The component CPT procedure code (A4961) cannot be billed to the carrier.
When the second CPT procedure code is not separately payable, the procedure code when presented on the hospital claim will be denied payment at the line item level.
Which modifier is used to describe two portable chest X-rays read by different physicians on the same day?
B. -77
Modifier -77 is applied to the CPT procedure code when two different physicians interpret the radiology results on the same patient, on the same day.
The National Correct Coding Initiative (NCCI) edits are maintained by which organization?
C. Centers for Medicare & Medicaid Services (CMS)
The NCCI was developed to promote national correct coding methods and to reduce/alleviate separate reporting of bundled services. It was also developed to control improper multiple procedure coding that leads to inappropriate payment of Part B (outpatient hospital claims).
According to the National Correct Coding Initiative (NCCI) edit tables, which CPT procedure code combination would be allowed with an appropriate modifier?
D. 36430, 96365
The only acceptable CPT procedure code pairing that would require a modifier is 36430, 96365. Modifier -59 is required.
