Understanding NCCI Edits and Modifier 59: Ensuring Accurate and Compliant Coding
Accurate coding is critical not only for proper reimbursement but also for maintaining compliance and avoiding payer audits. The National Correct Coding Initiative (NCCI), developed by the Centers for Medicare & Medicaid Services (CMS), is designed to promote correct coding and prevent inappropriate billing practices. However, navigating the complexities of NCCI edits and the correct use of Modifier 59 can be challenging even for experienced coding professionals.
This webinar provides a deep dive into NCCI edits, including Procedure-to-Procedure (PTP) edits and Medically Unlikely Edits (MUEs), and explains how to determine when modifiers are appropriate to bypass these edits. Special focus will be given to the appropriate use of Modifier 59, including its purpose, misuse risks, and how it differs from the more specific subset modifiers XE, XS, XP, and XU.
Participants will learn how to identify scenarios that warrant Modifier 59, understand what constitutes sufficient documentation, and apply best practices for compliant claim submission. We will also explore strategies for internal auditing, error prevention, and appeal preparation.
Whether you're a coder, biller, auditor, or compliance officer, this session equips you with the knowledge and tools to strengthen your modifier usage, reduce denials, and protect your organization from compliance risk.
Learning Objectives
Identify the correct use of Modifier 59 and distinguish it from related modifiers (e.g., XE, XS, XP, XU)
Develop internal review protocols and training strategies to improve modifier usage compliance and reduce denial rates
Understand the compliance risks of inappropriate Modifier 59 usage, including payer audits, claim denials, and potential fraud investigations
Apply best practices for documentation and coding accuracy to support Modifier 59 and ensure defensible claim submission
Areas Covered in the Session
Overview of the National Correct Coding Initiative (NCCI): Purpose, structure, and the CMS role in preventing improper coding.
Breakdown of NCCI Procedure-to-Procedure (PTP) Edits and Medically Unlikely Edits (MUEs): How they function, how to access them, and what they mean for claim processing.
Detailed Explanation of Modifier 59: Its intended use, documentation requirements, and regulatory risks.
Distinguishing Modifier 59 from XE, XS, XP, and XU: Understanding the CMS-defined subset modifiers and when to apply them instead.
Identifying Common Coding Scenarios Where NCCI Edits Apply: Real-world examples involving bundling edits, column 1/column 2 relationships.
Risks of Improper Modifier 59 Use: Common mistakes, compliance concerns, and how overuse can trigger audits.
Documentation Best Practices: What auditors and payers look for when Modifier 59 is used to bypass an edit.
Live Q&A Session
Suggested Attendees
Hospital Administrators
Clinic Owners
Providers - Physicians and NPPs
Medical Billing Professionals
Medical Coding Professionals
Practice Managers
Officer Managers
Information Officers
Compliance Officers
Regulatory/ Risk Officers
Healthcare Attorneys
About the Presenter
Ivonne Atanacio, CPC, CPB, CPMA, CRC, CPC-I, CEMC, CGSC, CASCC, is the Owner of A16 Coding Training Institute and A16 Coding LLC, a medical consulting firm. With over 24 years of experience in Revenue Cycle Management, she specializes in coding, billing, compliance, and physician documentation training. Ivonne has served in local AAPC chapter leadership, spoken at national conferences, and provides compliance implementation and strategic support for start-up practices. She is always enthusiastic about contributing to the educational side of healthcare and takes pride in empowering providers, staff, and her students through knowledge, mentorship, and real-world application.
Additional Information
System Requirement:
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to hear clearly
Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.
For more information, you can reach out to the below contact:
Toll-Free No: 1-302-444-0162
Email: care@skillacquire.com