NCCI logic could lead to no payment for claims, including comprehensive APCs

Why This Topic Matters

The article matters because it highlights claim-processing situations that can affect whether outpatient services receive payment and because it summarizes several CMS update changes that may require claim review, system updates, or coding workflow adjustments.

Article Sections

1. Comprehensive APC claim issues

   Discusses outpatient claim scenarios involving multiple comprehensive APC services and how claim-processing logic can affect payment outcomes. The section focuses on general APC and NCCI-related concerns for providers reviewing claims.

2. New codes and APCs

   Summarizes selected HCPCS code and APC update items from the October 2015 I/OCE cycle. The section includes new or revised outpatient code assignments and status indicator changes.

3. ICD-10's impact

   Reviews ICD-10-CM transition considerations and lists examples of diagnosis-list changes associated with the October 1, 2015 effective date. The section addresses claim splitting and general diagnosis edit maintenance.

4. Other changes

   Covers additional outpatient update items, including skin substitute, HCPCS, and modifier-related changes. The section also notes broader NCCI release activity and code-pair update totals.