National Correct Coding Initiative (NCCI)
The National Correct Coding Initiative (NCCI) is a CMS program of edits that flag code pairs and services that should not be billed together, to prevent improper payment.
Updated
The National Correct Coding Initiative (NCCI) is a set of CMS-developed coding edits designed to prevent improper payment by identifying code combinations that should not be reported together on the same claim for the same patient on the same date of service. It includes procedure-to-procedure edits (code pairs) and medically-unlikely edits (units of a service that exceed what would typically be furnished).
NCCI edits are categorized as either modifier-indicator edits, where an appropriate modifier may override the edit when the services are truly distinct, or non-modifier-indicator edits, where the combination is never appropriate and no modifier can override it.
In practice
Because NCCI edits are applied by Medicare and adopted by many other payers, billing a code pair that violates an edit commonly results in one code being denied or the line being reduced. Where the services are genuinely separate, the correct modifier (commonly one indicating distinct procedural services) can permit both — but only where the edit allows it. Applying a modifier where the edit forbids it does not make the claim payable.
Commonly confused with
- Claim scrubbing: Claim scrubbing is a payer- or clearinghouse-level pre-submission edit layer; NCCI edits are CMS-published national edits that payers and clearinghouses implement as a standard rule set.