This procedure or procedure/modifier combination is not compatible with another procedure or procedure /modifier combination provided on the same day according to the National Correct Coding Initiative. This denial is received when the service(s) has/have already been paid as part of another service billed for the same date of service. 

The basic principles for the correct coding policy are:

• The service represents the standard of care in accomplishing the overall procedure;
• The service is necessary to successfully accomplish the comprehensive procedure. Failure to perform the service may compromise the success of the procedure; and
• The service does not represent a separately identifiable procedure unrelated to the comprehensive procedure planned. 

Purpose:

• The purpose of NCCI edits is to ensure the most comprehensive codes, rather than component codes, are billed.

Where can I locate the procedure to procedure (PTP) code pair edits?

• The NCCI PTP lookup is a database on the First Coast website that allows you to search for code pair edits for Medicare services performed on a specific date of service.
• Quarterly updates are located on the CMS website at National Correct Coding Initiative (NCCI) edits

Helpful hints:

• If an NCCI associated modifier is clinically appropriate, then apply the appropriate modifier to the minor/column 2 code only. Effective with date of service July 1, 2019, modifier 59 or subsets may be applied to either the major or minor code for Part B services only. Proper Use of Modifier 59.
  • Exception: unless anatomical modifiers are used (such as RT and LT)
• Refer to the modifier policy indicator column in the PTP edit tables:
  • 0-modifier not allowed
  • 1-modifier is allowed
  • 9-not applicable (code pair no longer valid)
• Associated allowed NCCI modifiers that may be used include
  • Anatomic modifiers: E1-E4, FA, F1-F9, TA, T1-T9, LT, RT, LC, LD, RC, LM, RI
  • Global surgery modifiers: 24, 25, 57, 58, 78, 79
  • Other modifiers: 27, 59, 91, XE, XS, XP, XU
  • Never append a modifier to solely bypass an NCCI PTP edit.
  • Validate for the appropriate procedure/modifier combination via the Modifier lookup tool.
• Procedures are to be reported with the most comprehensive CPT code.
• Stay up to date with the quarterly CMS updates on NCCI page.
• Subscribe to the First Coast eNews for important changes to Medicare policies, informative articles, and upcoming educational events.

Educational resources:

CMS

• Refer to the NCCI Policy Manual for Medicare services, Chapter 1, Section E – (located in the download section on the CMS NCCI edits page) for general correct coding policies and guidelines on proper modifier usage.
• CMS IOM, Pub. 100-04, Chapter 23, section 20.9 – for additional details on correct coding