NCCI EDITS UPDATED ACTUAL Exam Questions and CORRECT Answers

NCCI EDITS UPDATED ACTUAL Exam
Questions and CORRECT Answers
NCCI - CORRECT ANSWER - National correct coding initiative



CCI - CORRECT ANSWER - Also known as National correct coding initiative, correct
coding initiative


NCCI - CORRECT ANSWER - Was implemented to promote National correct coding
methodologies and take control in proper coding leading to inappropriate payment


PTP - CORRECT ANSWER - Ncci procedure to procedure code pair edits are automated
prepayment edit that prevent improper payment when certain codes are submitted together for
Part B - covered services.


MUE's - CORRECT ANSWER - Medically unlikely edits



MUE - CORRECT ANSWER - Is a maximum number of units of service { UOS } allowable
under certain circumstances for a single Healthcare Common Procedure Coding System /Current
Procedural Training (HCPCS /CPT), code billed by a provider of service for a single beneficiary


HCPCS - CORRECT ANSWER - Healthcare common procedure coding system



CPT - CORRECT ANSWER - Common procedural training



PTP Service Denial - CORRECT ANSWER - May not be billed to Medicare beneficiaries, a
provider cannot utilize an advance beneficiary notice of non-coverage ABN, to seek payment
from a Medicare beneficiary. The ncci tools found on the centers for Medicare and Medicaid
services CMS website including the national correct coding initiative policy manual for
Medicare Services help providers avoid coding and billing errors and subsequent payment
denials.

, MAC - CORRECT ANSWER - Medicare administrative contractor, should be contacted
about payment adjustments when providers determine that claims have been coded incorrectly.


NCCI Tables - CORRECT ANSWER - Are updated quarterly and loaded into the Medicare
claims payment processing systems and onto the CMS and CCI web pages


NCCI policy manual for Medicare services - CORRECT ANSWER - Is updated annually



PTP Code Pair Edit - CORRECT ANSWER - simply represents two codes that should not be
reported together, unless an appropriate modifier is used


Mutually Exclusive Procedures - CORRECT ANSWER - cannot reasonably be performed at
the same anatomic site or same beneficiary procedure


Gender Specific Restriction - CORRECT ANSWER - on the use of the code HCPCS/CPT
codes specific for one gender should not be reported with HCPCS/CPT codes for the opposite
gender


When a code is the reimbursable code of a PTP code pair. - CORRECT ANSWER - 1. If a
provider submits the two codes of an edit pair for payment for the same beneficiary on the same
date of service, the Column 1 code is eligible for payment and the Column 2 code is denied.


2. If both codes are clinically appropriate and an appropriate NCCI-associated modifier is used,
the codes in both columns are eligible for payment.


Supporting documentation must be in the medical record.


Column 1 - CORRECT ANSWER - indicates the payable code