General Question for the Week of May 23, 2022

General Compliance Question of the Week

Question:

Can you explain to me what the NCCI is?

Answer:

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 whichn 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. A PTP edit identifies code pairs that are not separately billable when coded on the same date of service. An MUE identifies services with billed units greater than what is considered clinically appropriate. An AOC edit identifies a service that, with rare exceptions, should be performed in conjunction with another primary service by the same practitioner. The PTP edits and MUE limitations are updated quarterly. The purpose of the edits is to ensure appropriate coding and billing of services and to guide the proper payment of these services. The NCCI is updated through the course of the year and re-published each quarter with these changes. It is imperative that all practices and facilities required to bill under Medicare possess a current version of the material. The NCCI is Medicare’s most comprehensive bundling policy.


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