General Question for the Week of February 22, 2021

General Compliance Question of the Week


Can you tell me more about the background basics of NCCI edits?


Also known as “unbundling edits,” the National Correct Coding Initiative (NCCI) is of major importance to hospitals that bill outpatient Part B services to the Medicare Part A/B MAC. Under the Outpatient Prospective Payment System (OPPS), each billable code is paid according to the APC group to which the service has been assigned. In order to assure proper payment for services, Medicare will process claims against the NCCI edits for Part A/B billing. The NCCI includes a series of “edits” that Medicare and other third-party payers use to screen claims for appropriate billing and payment. As part of the NCCI, carriers implemented procedure-to-procedure (PTP) edits in January 1996, medically unlikely edits (MUEs) in January 2007, and add-on code (AOC) edits in April 2013.