National Correct Coding Initiative (NCCI)

The National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and controls improper coding leading to inappropriate payments in Medicare Part B claims. The purpose of the NCCI edits is to prevent improper payments when incorrect code combinations are reported. The Affordable Care Act of 2010 requires state Medicaid programs to incorporate "NCCI methodologies" in their claims processing systems by October 1, 2010.

NCCI Edits

The National Correct Coding Initiative (NCCI) consists of two types of edits:

1. NCCI procedure-to-procedure edits that define pairs of Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons;
   
   
2. Medically Unlikely Edits (MUE), units-of-service edits, that define for each HCPCS / CPT code the number of units of service beyond which the reported number of units of service is unlikely to be correct (e.g., claims for excision of more than one gallbladder or more than one pancreas).

Center for Medicare and Medicare Services NCCI Edit Information

• CMS NCCI Edit Overview Information

• CMS Information on Medically Unlikely Edits

• CMS NCCI Edits-Physicians

• CMS NCCI Edits-Hospital Outpatient PPS

• CMS Quarterly NCCI and MUE Version Update Changes

South Dakota NCCI Bulletins

• January 24, 2012 Bulletin
• Medically Unlikely Edit Bulletin
• NCCI - Provider Bulletin