Are there new billing practices involved with Medi-Cal’s implementation of NCCI?
CMS has identified a set of modifiers to facilitate NCCI claims processing. For claims where multiple encounters or other circumstances could appear to fail NCCI edits and lead to inappropriate claim denial, providers can use the following modifiers to accurately define the service encounter. (An asterisk indicates the modifier will be added for Medi-Cal use): Modifier Description (see code book for full description) Anatomical Modifiers E1 – E4 Anatomic areas of the eye lid F1 – F9, * FA * Hands and digits LC, * LD, * RC * Anatomic areas of the coronary arteries LT, RT Left and right sides of the body T1 – T9, * TA * Foot and toes Global Surgery Modifiers 25 Separate Evaluation & Management (E&M) on the same day 58 Staged or related procedure by same physician during postop period 78 Unplanned return to the operating/procedure room 79 Unrelated procedure or service during postop period Other Modifiers 59 Distinct procedural service 91 * Repeat clinical diagnostic laboratory test Medi-
Related Questions
- If a provider registers an NPI on the Medi-Cal Web site, but the provider’s internal electronic billing system hasn’t been tested for Medi-Cal billing, will the claims be denied?
- How can channels of communication be improved to help the implementation of good practices?
- How does the NPI implementation affect home infusion companies with billing?
