NCCI - Medicare National Correct Coding Initiative

Note Due to AMA copyright on CPT, you must be a registered user: either on free trial or subscription based - to use this part of the ICD10Doc application

Watch a brief YouTube movie and see how easy it is to code correctly with NCCI using ICD10Doc.

1. Find a CPT code that interests you, with the search or reverse search functions on the Home page. The result will show in its own box as CPT / HCPCS. Click on the link that you'd like to continue with.

2. Scroll down on the next screen to NCCI box.



Click on the Hospital NCCI or the Physician NCCI button.

The Hospital NCCI is available to Advanced subscribers only.







This Physician NCCI option is available to Advanced or Standard subscribers only.







Results show which other codes may or may not be submitted with a CPT code.

Background

Many procedure codes should not be reported together because they are mutually exclusive of each other. Mutually exclusive procedures cannot reasonably be performed at the same anatomic site or same beneficiary encounter.

NCCI has codes in pairs: Column 1/Column 2 are comprised of code pairs. If a provider submits the two codes of an edit pair for payment for the same beneficiary on the same date of service, the Column 1 code is eligible for payment and the Column 2 code is denied.
However, if both codes are clinically appropriate and an appropriate NCCI-associated modifier is used, the codes in both columns are eligible for payment. Supporting documentation must be in the beneficiary’s medical record.
The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment.
NCCI code pair edits are automated prepayment edits that prevent improper payment when certain codes are submitted together for Part B-covered services.
It is important to understand, however, that the NCCI does not include all possible combinations of correct coding edits or types of unbundling that exist. Providers are obligated to code correctly even if edits do not exist to prevent use of an inappropriate code combination. Should providers determine that claims have been coded incorrectly, they are responsible to contact their Medicare Administrative Contractor (MAC) about potential payment adjustments.
0 - Not allowed - There are no modifiers associated with NCCI that are allowed to be used with this code pair; there are no circumstances in which both procedures of the code pair should be paid for the same beneficiary on the same day by the same provider

1 - Allowed - The modifiers associated with NCCI are allowed with this code pair when appropriate.

9 - Not applicable - This indicator means that an NCCI edit does not apply to this code pair. The edit for this code pair was deleted retroactively.

NCCI Edits - Physicians
These code pair edits are applied to claims submitted by physicians, non-physician practitioners, and Ambulatory Surgery Centers (ASCs).
NCCI Edits - Hospitals
For the following Types of Bills (TOBs) subject to the Outpatient Code Editor (OCE):
Hospitals (TOB 12X and 13X), Skilled Nursing Facilities (SNFs), (TOB 22X and 23X), Home Health Agencies (HHAs), Part B (TOB 34X), Outpatient Physical Therapy, Speech-Language Pathology Providers (OPTs) (74X) and Comprehensive Outpatient Rehabilitation Facilities (CORFs) (TOB 75X) - click on button below to see which codes' pairs are allowed or not for these facilities:

For more information on NCCI visit CMS web site
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