Crystal's MCW Coder HubTags: ncci inpatient compliance
Definition
National Correct Coding Initiative edits prevent inappropriate code combinations.
Types of Edits
Procedure-to-Procedure (PTP)
- Two codes cannot be billed together
- May allow modifier if distinct
Medically Unlikely Edits (MUE)
- Maximum units per day
- Exceeding requires justification
Common Inpatient PTP Edits
| Column 1 | Column 2 | Modifier? |
|---|---|---|
| 99232 | 99233 | No (same day) |
| 99291 | 99231-99233 | No (same time) |
| 99221 | 99222 | No (same admission) |
| 99238 | 99239 | No (same day) |
Critical Care Bundling
Bundled with 99291
| Service | Code | Status |
|---|---|---|
| IV insertion | 36000 | Bundled |
| Venipuncture | 36415 | Bundled |
| NG tube | 43752 | Bundled |
| Vent management | 94002-94004 | Bundled |
Separate from 99291
| Service | Code | Status |
|---|---|---|
| Central line | 36556-36558 | Separate |
| Arterial line | 36620 | Separate |
| Intubation | 31500 | Separate |
| Chest tube | 32551 | Separate |
Same Day E/M Limitations
One Initial Per Admission
Only one initial hospital care code per admission per physician/specialty.
| Scenario | Allowed |
|---|---|
| Initial + Subsequent same day | No |
| Subsequent + Discharge same day | No (bill discharge only) |
| E/M + Critical Care same day | Yes (Modifier 25) |
| Two physicians same specialty | No (combine time) |
MUE Limits
| Code | Typical MUE | Notes |
|---|---|---|
| 99291 | 1 per day | First 74 minutes |
| 99292 | Variable | Each addl 30 min |
| 99238 | 1 per day | Discharge ≤30 min |
| 99239 | 1 per day | Discharge >30 min |
NCCI Tool
Use CMS NCCI PTP editor tool to verify code combinations before billing.
00 Inpatient ProFee Coding MOC Critical Care Codes Inpatient Modifiers