Correct Coding Initiative Works Towards Averting Improper Payment

The National Correct Coding Initiative (NCCI) was developed by the Centers for Medicare and Medicaid Services (CMS) to promote national correct medical coding methodologies and to control inappropriate coding leading to incorrect payment. The CMS (then the Health Care Financing Administration) had implemented the first round of correct coding edits in the year 1996.

These code edits are pairs of Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Level II codes that aren't payable separately except in certain circumstances. These edits are applied to services billed by the same provider for the same beneficiary on the same date of service.

NCCI comprises two tables of edits - Column 1 /Column 2 Correct Coding Edits table and Mutually Exclusive Edits table. Previously Column 1 /Column 2 edits were known as Comprehensive/Component edits. Column 1 code includes the Column 2 code; hence Column 2 should not be billed separately. The second category, the Mutually Exclusive Edits identify coding combinations comprising two procedures that cannot be performed together based on the CPT code definition, anatomic considerations or standard of medical practice.

The CMS updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual) annually. You can avail the Correct Coding Initiative Edits Manual in two ways. Firstly, you can go to the CMS Website cms.hhs.gov/NationalCorrectCodInitEd/. The Website contains a list of the CPT edits and is free for downloading. Secondly, you can avail it by purchasing the manual or sections of the manual from the National Technical Information services (NTIS) .

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