Ready for the New NCCI Edits Coming in July 2007?

The new edits coming in July 2007 will mainly affect ER room practicioners and physicians and nurses that treat patients in nursing home facilities. These updates will be items you need to know in order to avoid denials and get maximum reimbursements on your medical billing claims.

The codes that were changed in the upcoming release were codes 99281-99285 (Emergency department services) are considered component codes of the more global 99304-99306 codes (Initial nursing facility care). This means if a single physician provides a level-two ED service along with a level-two initial nursing home service, you should only report 99305 (Initial nursing facility care, per day, for the evaluation and management of a patient which requires these three key components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity).

Do not include 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of low complexity) on the claim, because it is bundled into 99305.

Another item to be on the lookout for: if you have more than one physician or nurse that admit patients to nursing homes and oversee care, remember they will be reporting under the same tax identification number because they work out of the same hospital or specialty group. This can get kicked out by the carrier as a duplicate billing so be sure to show in your documentation that separate charges are being submitted to avoid delays and denials in reimbursements.

View all Articles by: Kathryn E, CCS-P - Retired