NCCI Edits and Modifier 59: Coding Accuracy and Compliance

Accurate medical coding is essential not only for ensuring proper reimbursement but also for maintaining compliance and preventing costly payer audits. The National Correct Coding Initiative (NCCI)—developed by the Centers for Medicare & Medicaid Services (CMS)—plays a vital role in promoting correct coding practices and reducing billing errors. However, understanding the complexities of NCCI edits and knowing when and how to use Modifier 59 correctly can be challenging, even for experienced professionals.

This comprehensive webinar offers a deep dive into NCCI edits, including both Procedure-to-Procedure (PTP) edits and Medically Unlikely Edits (MUEs), and explains how to determine when modifiers may be appropriately applied to bypass these edits. Attendees will gain clarity on the correct and compliant use of Modifier 59—its intent, limitations, and documentation requirements—as well as its distinctions from the CMS-defined subset modifiers XE, XS, XP, and XU.

Participants will explore real-world scenarios where Modifier 59 may be necessary, understand the risks of misuse, and learn best practices for ensuring defensible claim submission. The session also covers strategies for internal auditing, denial prevention, and training staff to recognize and apply modifiers appropriately.

Whether you are a coder, biller, auditor, provider, or compliance professional, this training will equip you with the tools and knowledge to strengthen modifier accuracy, minimize compliance risk, and reduce denials across your organization.

Learning Objectives

• Define the correct and compliant use of Modifier 59 and differentiate it from XE, XS, XP, and XU.

• Develop internal review and training protocols to improve modifier accuracy and reduce claim denials.

• Identify compliance risks associated with inappropriate Modifier 59 use, including audit exposure and payer scrutiny.

• Apply documentation and coding best practices to ensure proper claim support and defensible submission.

Areas Covered in the Session

• Overview of the National Correct Coding Initiative (NCCI): Purpose, structure, and CMS’s role in ensuring coding integrity.

• Procedure-to-Procedure (PTP) and Medically Unlikely Edits (MUEs): Understanding how edits function and impact claims.

• Detailed Review of Modifier 59: When and how to use it correctly, including documentation standards and compliance implications.

• Subset Modifiers XE, XS, XP, and XU: When to apply each instead of Modifier 59.

• Common Coding Scenarios: Real-world examples illustrating bundling edits, column 1/column 2 relationships, and edit bypassing.

• Compliance Risks and Audit Triggers: Avoiding overuse or misuse of Modifier 59.

• Documentation Essentials: What payers and auditors expect to see when Modifier 59 is reported.

• Live Q&A Session

Suggested Attendees

• Hospital and Clinic Administrators

• Physicians and Non-Physician Practitioners (NPPs)

• Medical Coders and Billers

• Practice and Office Managers

• Compliance, Risk, and Regulatory Officers

• Revenue Cycle and Information Officers

• Healthcare Attorneys and Legal Advisors

• Auditors and Compliance Specialists

• Healthcare Consultants and Trainers

About the Presenter

Ivonne Atanacio, CPC, CPB, CPMA, CRC, CPC-I, CEMC, CGSC, CASCC
Owner, A16 Coding Training Institute & A16 Coding LLC

Ivonne Atanacio is a nationally recognized expert in medical coding, billing, and compliance, bringing more than 24 years of experience in Revenue Cycle Management. As the founder of A16 Coding Training Institute and A16 Coding LLC, she provides consulting, training, and compliance guidance to healthcare organizations and provider groups nationwide.

Her career includes extensive work in physician documentation, coding audits, and compliance implementation for start-up and established practices. Ivonne is also a respected educator and speaker, having presented at national conferences and served in leadership roles within local AAPC chapters. Passionate about professional growth and education, she empowers healthcare providers, billing teams, and students through mentorship and hands-on training that translates complex regulations into practical, real-world understanding.