Find-A-Code Focus Newsletter

NCCI 20.3 Analysis - by Frank Cohen

October 01, 2014
I have completed my analysis of the NCCI 20.3 release and following are my general findings:

New Edits
  1. There are 5,247 new edit pairs, bringing the total to number of active edits to 1,340,210
  2. The top four codes for column 1 are C9740, C9739, 0356T and 347T, but these only account for just over 16% of column 1 codes
  3. The top group for column 2 codes are mostly shared by T-codes, with the top 15 accounting for just over 50% of the column 2 codes
  4. Nearly 50% of column 1 codes are E/M codes, which is quite significant and almost 60% of column 2 codes are Category III (T) codes
  5. “Misuse of column two code with column one code” accounts for 63% of the policy edits for total pairs
  6. Of the 5,247 new edits, all but two were effective 10/1/2014 with the two stragglers effective retroactively to 1/1/2014
Terminated Edits
  1. There are only 31 terminated edits
  2. 90% of both column 1 and column 2 codes are within the CPT Medicine category
  3. “Standards of medical/surgical practice” was the dominate policy statement accounting for 64% of edit pairs
  4. All 31 terminated edit pairs are effective on 9/30/2014
Modifier Changes
  • There were 248 changes to the modifier indicators with all but one going from ‘1’ (you may be able to bypass using a modifier) to a ‘0’ (a modifier is never appropriate
Duplicates
  • There are currently 13,802 duplicate pairs within the database, meaning that the pair was active at one point, then deleted and then reactivated
Final counts are 1,340,210 active edit pairs and 280,357 terminated pairs for a total of 1,620,567 total edit pairs within the database. I have posted a detailed file that supports this analysis at Frank Cohen Library.
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