Table of Contents
- 1 What is the importance of NCCI?
- 2 What are NCCI coding policies based on?
- 3 What is NCCI edits coding?
- 4 How often are NCCI edits updated?
- 5 Can NCCI Edits be appealed?
- 6 What does NCCI stand for in coding?
- 7 Where is the National correct coding initiative ( NCCI ) located?
- 8 How to tell if a NCCI edit is a claim line?
What is the importance of NCCI?
Founded in 1923, the mission of the National Council on Compensation Insurance (NCCI) is to foster a healthy workers compensation system. In support of this mission, NCCI gathers data, analyzes industry trends, and provides objective insurance rate and loss cost recommendations.
What are NCCI coding policies based on?
NCCI coding policies are based on coding conventions defined in the American Medical Association’s CPT nomenclature, national and local Medicare policies and edits, coding guidelines developed by national societies, standard medical and surgical practice, and/or current coding practice.
Who do NCCI Edits apply to?
National Correct Coding Initiative (NCCI) Edits Apply to OPPS and Non-OPPS Claims. The Centers for Medicare and Medicaid Services (CMS) developed the NCCI edits to promote national correct coding methodologies. The purpose of NCCI edits is to prevent improper payment when incorrect code combinations are reported.
What does NCCI stand for in healthcare?
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.
What is NCCI edits coding?
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 purpose of the NCCI PTP edits is to prevent improper payment when incorrect code combinations are reported.
How often are NCCI edits updated?
The CMS annually updates the National Correct Coding Initiative Policy Manual for Medicare Services. The NCCI Policy Manual should be used by Medicare Administrative Contractors (MACs) as a general reference tool that explains the rationale for NCCI edits.
What are NCCI edits used for?
The purpose of the NCCI 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.
Do NCCI edits apply to all payers?
Technically, the NCCI edits only apply to Medicare fee-for-service, but the majority of commercial payers do use the NCCI edits in their systems, so there’s a good chance you’ll need to comply with the edits even if you aren’t working with Medicare.
Can NCCI Edits be appealed?
Appeals must be submitted to your responsible MAC or QIC, not the NCCI Contractor. To file an appeal, please follow instructions on the Appeals website. The NCCI contractor cannot process specific claim appeals, and cannot forward appeal submissions to the appropriate appeals contractor.
What does NCCI stand for in coding?
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.
How do NCCI edits work?
The NCCI contains two provider-type choices of Procedure-to-Procedure (PTP) code pair edits and three provider-type choices of Medically Unlikely Edits (MUEs). PTP code pair edits are automated prepayment edits that prevent improper payment when certain codes are submitted together for Part B-covered services.
How are Medically Unlikely Edits defined in NCCI?
40652 NCCI MEDICALLY UNLIKELY EDITS: Medically Unlikely Edits (MUE) these are units of-service edits. This component defines for each HCPCS/CPT code the number of units of service that is unlikely to be correct.
Where is the National correct coding initiative ( NCCI ) located?
Information about the National Correct Coding Initiative (NCCI) can be found in the Internet-Only Manual, Publication 100-04, Section 20.9 of Chapter 23 of the Medicare Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs
How to tell if a NCCI edit is a claim line?
The MUE files on the CMS NCCI webpage display an “MUE Adjudication Indicator” (MAI) for each HCPCS/CPT code. An MAI of “1” indicates that the edit is a claim line MUE. An MAI of “2” or “3” indicates that the edit is a date of service MUE. Further information is available in MLN Matters MM8853 (PDF).
Is there a way to bypass NCCI edits?
If necessary please note that you can utilize NCCI-associated Modifiers to bypass NCCI edits, if in accordance with coding guidelines and if applicable to the services rendered. 13 © Copyright 2010 Hewlett-Packard Development Company L.P. PROVIDERS AFFECTED NCCI PROCEDURE-TO-PROCEDURE EDITS Outpatient Hospital Services Drugs Radiology