Medical coding - What is NCCI EDITS - How to NCCI EDIT


CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and eliminate improper coding. NCCI edits are developed based on coding conventions defined in the American Medical Association’s CPT book, current standards of medical and surgical coding practice, input from specialty societies, and analysis of current coding practice.

What Are NCCI Edits?

NCCI edits are pairs of CPT or HCPCS Level II codes that are not separately payable except under certain circumstances. The edits are applied to services billed by the same provider for the same beneficiary on the same date of service. All claims are processed against NCCI tables.

There are two types of edits arranged by two sets of tables:

• Column 1/Column 2 Correct Coding Edits (formerly Comprehensive/Component) – identifies code pairs that should not be billed together because one service is an integral part of the other or should not be reported together for other reasons (e.g., “misuse of the code,” etc.).

• Mutually exclusive edits – identifies code pairs that, for clinical reasons, are unlikely to be performed on the same patient on the same day. For example, a mutually exclusive edit might identify two different types of testing that yield equivalent results.

All edits consist of code pairs that are arranged in two columns (Column 1 and Column 2). Codes that are listed in Column 2 are not payable if performed on the same day on the same patient by the same provider as the code listed in Column 1 unless the edits permit the use of a modifier associated with NCCI. Column 1 generally represents the major procedure or service and Column 2 often represents the component part of the Column 1 code. However, within the mutually exclusive edits table, the Column 2 code generally represents the procedure or service with the higher work Relative Value Unit (RVU) and is the non-payable procedure or service when reported with the Column 1 code.

How Often Are the NCCI Edits Changed?

The NCCI edits are under constant refinement. Revisions to the NCCI edits are published quarterly (January 1, April 1, July 1 and October 1).

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