The National Correct Coding Initiative (NCCI) Edits are a set of coding guidelines developed by the Centers for Medicare & Medicaid Services (CMS) to prevent improper payment for healthcare services. The edits identify services that should not be billed together, either because they are included in a more comprehensive service or because they are not typically performed together.
There are two main types of NCCI edits:
Procedure to Procedure (PTP) edits: These edits identify pairs of codes that should not be billed together. For example, a PTP edit would prevent a provider from billing both a code for a knee replacement and a code for a knee arthroscopy, because the arthroscopy is included in the knee replacement.
Medically Unlikely Edits (MUEs): These edits identify codes that are considered to be unlikely to be performed together. For example, an MUE would prevent a provider from billing both a code for a colonoscopy and a code for a cardiac catheterization, because these two procedures are not typically performed together.
How do NCCI Edits work?
NCCI Edits are used by Medicare Administrative Contractors (MACs) to review healthcare claims. When a claim is submitted, the MACs use the NCCI Edits to determine whether the codes on the claim are allowed to be billed together. If the codes are not allowed to be billed together, the claim will be denied.
Why are NCCI Edits important?
NCCI Edits are important because they help to ensure that Medicare payments are accurate and appropriate. By preventing improper payment for healthcare services, NCCI Edits help to protect the Medicare Trust Fund.
How can I learn more about NCCI Edits?
The CMS website provides a comprehensive resource on NCCI Edits, including the NCCI Policy Manual, the NCCI Edits Search Tool, and the NCCI Edits Training Tutorial. You can also find information about NCCI Edits from a variety of other sources, including professional organizations, coding and billing experts, and healthcare payers.
Here are some tips for avoiding NCCI denials:
Use a coding and billing software that is compliant with NCCI Edits.
Stay up-to-date on the latest NCCI Edits changes.
Review your claims carefully before submitting them.
If you have any questions about NCCI Edits, consult with a coding and billing expert.
By following these tips, you can help to ensure that your healthcare claims are processed correctly and that you avoid NCCI denials.