- ABN Modifiers
- American Medical Association and Current Procedural Terminology
- CMS Forms and Publications
- CMS Regional Offices
- Clinical Lab Improvement Amendment
- Comprehensive Error Rate Testing
- Electronic Health Records
- Electronic Prescribing
- Evaluation and Management Documentation Guidelines
- Federal Register
- Health Insurance Portability and Accountability Act of 1996
- Interactive Voice Response System
- Limitation of Liability (Advance Beneficiary Notice of Noncoverage)
- Local Coverage Determination
- Medically Unlikely Edits
- Medicare Coverage Database
- Medicare Electronic Data Interchange
- Medicare Fraud and Abuse
- Medicare Learning Network®
- Medicare Provider-Supplier Enrollment with NGS
- NGS Internet Resources
- NGSConnex Online Web Application Can Save Time and Money
- NGS Check Provider Enrollment Application Status Tool
- National Correct Coding Initiative
- National Coverage Determination
- National ICD-10-CM-PCS: The Next Generation of Coding
- National Provider Calls and Events
- National Provider Identifier
- National Provider Identifier Registry
- National Uniform Claim Committee
- Open Door Forums
- P.O. Box Mailing Addresses
- Patient Protection and Affordable Care Act of 2010
- Physician Quality Payment Program
- Provider Contact Center
- Provider Enrollment
- Reconsideration (Second Level of Appeal)
- Recovery Audit Program
- Redetermination (First Level of Appeal)
- Skilled Nursing Facility Consolidated Billing
- U.S. Government Printing Office
- Washington Publishing Company
National Correct Coding Initiative
In 1996, CMS developed the NCCI to promote national correct coding methodologies and to eliminate improper coding. NCCI edits are developed based on coding conventions defined in the American Medical Association’s CPT Manual, current standards of medical and surgical coding practice, input from specialty societies and analysis of current coding practice.
The edits were developed based on anatomic considerations, HCPCS/CPT code descriptors, CPT instructions, CMS policies, nature of service/procedure, nature of analyte, nature of equipment and clinical judgment. Prior to implementation, all edits were reviewed by national healthcare organizations and their alternative recommendations were taken into consideration.
NCCI includes two types of edits:
- Comprehensive/component edits identify code pairs that CMS determined should not be billed together because one service inherently includes the other (bundled services). The code describing a broader and inclusive set of services is identified as being “comprehensive.” While the code describing a more discrete service that is actually a subcomponent of the broader service is described with the term “component.” Since the component code represents a portion of the service described by the comprehensive code it is therefore bundled and may not be reported separately. When two bundled procedures are submitted for the same patient during the same session, Medicare payers will ordinarily pay you only for the higher-valued between the two.
- Mutually exclusive edits identify code pairs that Medicare has determined, 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. When two mutually exclusive services are submitted on a claim, only the service of lesser value will be reimbursed.
NCCI edits are updated quarterly and can be found on the CMS website. For the NCCI Policy Manual and the latest version of the NCCI Edits, visit the National Correct Coding Initiative Edits web page.
If you have concerns regarding specific NCCI edits, please submit your comments in writing to:
Reviewed 10/13/2023