Crystal's MCW Coder HubTags: ncci compliance edits
Definition
National Correct Coding Initiative (NCCI) edits prevent payment for inappropriate code combinations.
Types of Edits
- Procedure-to-Procedure (PTP): Two codes cannot be billed together unless a modifier is used.
- Medically Unlikely Edits (MUE): Maximum units billable per day.
Common PM&R PTP Edits
| Column 1 (Payable) | Column 2 (Bundled) | Modifier Allowed? |
|---|---|---|
| 97140 (Manual) | 97124 (Massage) | No (Mutually Exclusive) |
| 97110 (Ther Ex) | 97530 (Ther Act) | Yes (if distinct) |
| 20552 (Trigger Pt) | 97140 (Manual) | Yes (if distinct site) |
MUE Limits
- 97140: Typically max 8 units/day per provider.
- 97110: Typically max 8 units/day per provider.
- Exceeding MUE: Requires documentation justification and often modifier 59 or XS.
Same Day Therapy
You cannot bill 97124 (Massage) and 97140 (Manual Therapy) for the same body part on the same day. They are mutually exclusive.