NCCI Bundling Denials

Denial Reason, Reason/Remark Code(s)

• M-80: Not covered when performed during the same session/date as a previously processed service for the patient
• CO-B15: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.

Correct Coding Initiative: The National Correct Coding Initiative (NCCI) packages/bundles reimbursement for some services under Medicare. NCCI identifies code pairs that are never reimbursed separately and code pairs that can only be reimbursed separately in certain circumstances (identified by the appropriate modifier).

Resolution/Resources

• Check NCCI edits prior to claim submission; edits are updated quarterly on CMS' website
• For specific information on modifiers that may be used to denote exceptions to NCCI (including CPT modifiers 24, 25, 59, 76 and 91), refer to the Palmetto GBA Modifier Lookup tool from the Self Service section on the Palmetto GBA Web page

  Is the NCCI indicator '0'?
  These code pairs will not be reimbursed if submitted for the same date of service. Exceptions to NCCI edits cannot be made for code combinations with an indicator of '0'

Is the code indicator '1'?

• Submit the appropriate modifier to show the service should be separate. Documentation is required in the patient's medical record. Exceptions to NCCI edits can be made for code combinations with an indicator of '1'.
• Examples of separate, distinct services include situations in which a bundled service was performed during a different patient encounter