How to Avoid NCCI Reductions from State Farm

What are NCCI reductions?
NCCI stands for National Correct Coding Initiative. If you check your EOB’s from State Farm (2008-2012) you will see denial codes for NCCI. If this happened to you prior to January 1, 2013 then State Farm was wrong for doing this. After January 1, 2013 most companies are going to apply NCCI reductions to your bills and it will be legal. If you’re bill gets denied then it is a coding issue that you can easily fix. It’s not a loophole; it’s strictly a coding issue.

Why were NCCI edits created?
To avoid unbundling. Medicare views unbundling as a type of “billing fraud” and NCCI edits are a way to reduce that. Keep in mind, this is really just a way for Medicare to save money– by reducing/denying bills.

Why are PIP insurance companies applying NCCI reductions to my bills?
Insurance companies save money every time they deny a bill. If a PIP insurance company applied NCCI reductions to your bills and you are a chiropractor then you probably billed 97124 (massage), 97112 (neuromuscular re-ed), or 97140 (manual therapy) on the same day as an adjustment (98940-98942). Medicare requires that therapy codes be performed on a separate anatomic site from where an adjustment is performed. If no 59 modifier (separate anatomic site) is present then your therapy code will probably be denied.

Look at your EOB’s from State Farm between 2008-2012 and if your bills were denied then call my office to see if we can get you paid.

To learn more about the definition of “separate anatomic sites” click here.

How do I avoid NCCI reductions? *
What can I do to avoid NCCI reductions?*

If you perform therapy on the same day as an adjustment then:

  1. You will need to perform the therapy on a different location of the body from the adjustment. There is no medical basis for this– just a coding technicality! For example, if a patient gets their lumbar adjusted then who is Medicare to say that therapy on the lumbar is unnecessary?
  2. You will need to add a -59 modifier to your therapy code.
  3. You will need to document your notes and show that one area was adjusted and a different area received therapy.

Again, this is not a loophole. This is merely a rule made up by Medicare coders. Look at your EOB’s from State Farm between 2008-2012 and if your bills were denied then call my office to see if we can get you paid.

Dr. Kotlar of Target Coding is a Coding Expert. Click here to see his information on NCCI reductions.

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