Gastroenterology Coding Alert

Question: Which National Correct Coding Initiative (NCCI) edits should we use - Medicare's or the national version?

Illinois Subscriber
 
Answer: There is only one set of NCCI edits, and it applies to both private and Medicare carriers.
 
CMS contracts with AdminaStar Federal, a Medicare carrier in Indiana, to propose and maintain a system of coding edits for Medicare Part B carriers. The National Correct Coding Initiative, the only authorized distributor, publishes the edits quarterly.
 
Some discrepancy occurs as to whether publications and companies use the abbreviation "NCCI" or "CCI." But the abbreviations refer to the same edits. Some entities, such as the CMS Web site and the AMA, refer to the edits as the Correct Coding Initiative (CCI) edits. The CMS policy narrative that AdminaStar releases with the National Correct Coding Policy Manual calls them the National Correct Coding Initiative (NCCI) edits.
 
CMS developed the NCCI to promote national correct coding methods and to control improper coding that leads to inappropriate payment in Part B claims, according to the narrative. The agency bases the policies on coding conventions defined in the CPT manual, national and local policies and edits, national societies' coding guidelines, standard medical and surgical practice analysis, and review of current coding practice. For more on the edits, visit www.cms.hhs.gov/medlearn/ncci.asp.