National Correct Coding Initiative (NCCI) Reminder

The National Correct Coding Initiative (NCCI) is a program owned by the Centers for Medicare & Medicaid Services (CMS), which is responsible for all decisions regarding its contents. Following is general information regarding NCCI to help better understand its purpose and use.

What is the NCCI? 

The National Correct Coding Initiative was developed by CMS to control improper coding leading to inappropriate and duplicate payment. The Affordable Care Act (ACA) requires that all state Medicaid programs incorporate “NCCI methodologies” in their claims processing; these edits are not specific to North Carolina Medicaid policies. 

Types of NCCI Edits

The NCCI contains two types of edits:

• NCCI procedure-to-procedure (PTP) edits define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should never be reported together. There are some code pairs that should only be used together under certain conditions by using specific modifiers. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported.
• 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.

Resources relating to NCCI Edits

• CMS Website
  • The National Correct Coding Initiative in Medicaid https://www.medicaid.gov/medicaid/program-integrity/national-correct-coding-initiative-medicaid/index.html
• Provider User Guides and Training
  • Claims Submission
    • Understanding NCCI Edits https://www.nctracks.nc.gov/content/public/providers/provider-user-guides-and-training/fact-sheets.html
• Medicaid NCCI Manuals
  • https://www.medicaid.gov/medicaid/program-integrity/national-correct-coding-initiative/medicaid-ncci-reference-documents/index.html 

Note: This article has also been published as an NC Medicaid Bulletin, available here.