Wednesday, August 26, 2015

What is National Correct Coding Initiative Edits

For the first quarter of 2015, additional hospital and physician NCCI edit files have been provided which contain an edit rationale column.   These files, labeled as “NTIS format” are formatted to match the files previously supplied by NTIS.  For the January, 2015 release the structure of the current NCCI edit data files will remain unchanged and both versions will be posted.  However, these two files structures will be consolidated into a single format for future releases.

Important notice to all NCCI Users concerning the National Correct Coding Initiative Policy Manual for Medicare Services:
The annual updated version of the National Correct Coding Initiative Policy Manual for Medicare Services will be effective January 1, 2015.  Additions/revisions to the manual have been italicized in red font.

National Correct Coding Initiative
The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the American Medical Association's CPT Manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual).  The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits.

Carriers implemented NCCI edits within their claim processing systems for dates of service on or after January 1, 1996.

A subset of NCCI edits is incorporated into the outpatient code editor (OCE) for OPPS and therapy providers (Skilled nursing facilities (SNFs), comprehensive outpatient rehabilitation facilities (CORFs), outpatient physical therapy and speech-language pathology providers (OPTs), and home health agencies (HHAs) billing under TOBs 22X, 23X, 75X, 74X, 34X).

The purpose of the NCCI edits is to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits for physicians/practitioners and one table of edits for outpatient hospital services. The Column One/Column Two Correct Coding Edits table and the Mutually Exclusive Edits table have been combined into one table and include code pairs that should not be reported together for a number of reasons explained in the Coding Policy Manual.

The Correspondence Language Manual available below has been written and maintained for utilization by the Medicare Contractors to answer routine correspondence inquiries about the NCCI procedure to procedure and MUE edits.  The general correspondence language paragraphs explain the rationale for the edits.  The section-specific examples add further explanation to the NCCI or MUE edits and are sorted by edit rationale and CPT code section (00000, 10000, 20000, etc.).  Please refer to the Introduction of this Manual for additional guidance about its use.

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