WNSM - What is the National Correct Coding Initiative (NCCI) and How Do I Use It?

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What is the National Correct Coding Initiative (NCCI) and How Do I Use It?

7/16/2024

What is the National Correct Coding Initiative (NCCI) and How Do I Use It?
By Noreen Robins, Lead Funding Specialist

NCCI is a CMS program that consists of coding policies and edits. Providers report procedures or services performed on beneficiaries utilizing Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes. These codes are submitted on claim forms to fiscal agents for payment. NCCI policies and edits address procedures or services performed by the same provider for the same beneficiary on the same date of service. The coding policies of NCCI are based on coding conventions defined in the American Medical Association’s Current Procedural Terminology Manual, national and local policies and edits, coding guidelines developed by national societies, standard medical and surgical practice, and/or current coding practice.

NSM has us covered!

Here at NSM we have built some of these procedural edits into our Coding & Pricing Check tool directly in Mobility Advisor! We also have a Medicare Resource Workbook that has many tools to make sure we are coding per NCCI standards. Our workbook includes check lists as well as what HCPC’s should be included and modifiers that should be used. There is also a tab to see if a HCPC requires a Rent/Purchase Option Letter and verbiage that you can use for an ABN. The Medicare Resource Workbook can be found on WNSM-Departments-Funding-Medicare-Medicare References-Medicare Resource Workbook which was last updated on 3/26/24 or in the UPD. This workbook is updated regularly, so it is best to save the live link from WNSM or view it in the UPD, vs. downloading to your desktop.

What if the Insurance does not follow NCCI Methodology?

There are some payers to that do not follow NCCI methodology for Procedure to Procedure Edits (PTP). If the UPD clearly states the payer does not follow NCCI Edits, there is a small chance that some items that are typically not separately billable, may be billable. These should be clearly documented in the UPD as separately billable items and as a payer that does not follow NCCI edits. When in doubt and the information isn’t clear in the UPD, it is best to follow NCCI edits or to validate with the payer or payer relations by entering a PSP ticket. Even though the payer may not follow NCCI edits, we must still use the most appropriate HCPC and follow all payer guidelines.