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NCCI Information

The National Correct Coding Initiative (**NCCI**) contains two types of edits: NCCI procedure-to-procedure (PTP) edits and Medically Unlikely Edits (MUEs).

Types of NCCI Edits

The National Correct Coding Initiative (NCCI) contains two types of edits:

  1. NCCI procedure-to-procedure (PTP) edits that define pairs of Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported.
  2. Medically Unlikely Edits (MUEs) define for each HCPCS / CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service.

The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding, which may result in inappropriate payments of Medicare Part B claims and Medicaid claims.

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 Procedure-to-Procedure(PTP) edits within their claim processing systems for dates of service on or after January 1, 1996 and began implementing Medically Unlikely Edits (MUE) on January 1, 2007.

A corresponding set of PTP edits is incorporated into the outpatient code editor (OCE) for OPPS and therapy providers [Part B Skilled nursing facilities (SNFs), comprehensive outpatient rehabilitation facilities (CORFs), outpatient physical therapy and speech-language pathology providers (OPTs), and certain claims for home health agencies (HHAs) billing under TOBs 22X, 23X, 75X, 74X, 34X]. Corresponding MUE are similarly implemented within the Fiscal Intermediary Shared System (FISS).

The purpose of the NCCI Procedure-to-Procedure (PTP) 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 PTP code pairs that should not be reported together for a number of reasons explained in the Coding Policy Manual. The purpose of the NCCI MUE program is to prevent improper payments when services are reported with incorrect units of service.

How do I obtain the National Correct Coding Initiative (NCCI) Policy Manual?

The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services may be obtained through the CMS website at http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.

The CMS website also contains a listing of the NCCI edits, which is available free to the public. Click HERE for CMS.GOV’s NCCI Edits FAQ

Click HERE to view MLN’s How-To-Use-NCCI-Tools

The National Correct Coding Initiative (**NCCI**) contains two types of edits: NCCI procedure-to-procedure (PTP) edits and Medically Unlikely Edits (MUEs).

Types of NCCI Edits

The National Correct Coding Initiative (NCCI) contains two types of edits:

  1. NCCI procedure-to-procedure (PTP) edits that define pairs of Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported.
  2. Medically Unlikely Edits (MUEs) define for each HCPCS / CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service.

The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding, which may result in inappropriate payments of Medicare Part B claims and Medicaid claims.

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 Procedure-to-Procedure(PTP) edits within their claim processing systems for dates of service on or after January 1, 1996 and began implementing Medically Unlikely Edits (MUE) on January 1, 2007.

A corresponding set of PTP edits is incorporated into the outpatient code editor (OCE) for OPPS and therapy providers [Part B Skilled nursing facilities (SNFs), comprehensive outpatient rehabilitation facilities (CORFs), outpatient physical therapy and speech-language pathology providers (OPTs), and certain claims for home health agencies (HHAs) billing under TOBs 22X, 23X, 75X, 74X, 34X]. Corresponding MUE are similarly implemented within the Fiscal Intermediary Shared System (FISS).

The purpose of the NCCI Procedure-to-Procedure (PTP) 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 PTP code pairs that should not be reported together for a number of reasons explained in the Coding Policy Manual. The purpose of the NCCI MUE program is to prevent improper payments when services are reported with incorrect units of service.

How do I obtain the National Correct Coding Initiative (NCCI) Policy Manual?

The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services may be obtained through the CMS website at http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.

The CMS website also contains a listing of the NCCI edits, which is available free to the public. Click HERE for CMS.GOV's NCCI Edits FAQ

Click HERE to view MLN's How-To-Use-NCCI-Tools

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