Ensure Faster Claims Processing by Using Correct Billing Codes

The National Correct Coding Initiative (NCCI), which promotes national correct coding methodologies and controls improper coding and incorrect payments for medical services, includes three types of edits:

  1. NCCI Procedure-to-Procedure Edits prevent inappropriate payment of services that should not be reported together.
  2. Add-on Code Edits consist of a listing of Healthcare Common Procedure Coding System and Current Procedural Terminology (CPT) add-on codes with their respective primary codes.
  3. Medically Unlikely Edits (MUEs) prevent payment for an inappropriate number/quantity of the same service on a single day.

When billing for services involving both sides of the body, include modifier 50 (bilateral procedure) or RT/LT, as applicable, based on correct coding guidelines. If you use modifier 50, do not add two units as the modifier 50 already applies two units to any CPT code. If the definition of a CPT code indicates multiple views, the claim line should be billed with one unit. If a code/service that can be performed on two sides has an MUE limit of one, bilateral modifier 50 must be used. A second claim line with either modifier RT or LT will be denied for exceeding the allowed MUEs or units.

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