Often, physicians and coders have questions on the services bundled by National Correct Coding Initiative (NCCI) edits and when it is appropriate to append a modifier that may override an NCCI edit. Sources of reference include Current Procedural Terminology (CPT®) code descriptors and instructions, coding instructions from individual payers, and the Medicaid NCCI manual. The Medicaid NCCI manual is updated each fall with changes from the previous year shown in red font. This article reviews changes to the manual that may be of interest to pediatricians in 2016.

Medicaid NCCI edits and guidance may vary from CPT and are not used by all payers. Private payers may use Medicare NCCI or other bundling edits. Where edits conflict with CPT code descriptors and instructions, verify individual payer guidance for reporting. Follow CPT instructions when there is no payer guidance for services provided.

If an endoscopic procedure is performed at...

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