General Surgery Coding Alert

Question: Who should I reach out to if I have inquiries regarding an appeal for a National Correct Coding Initiative (NCCI) claim rejection?

AAPC Forum Participant

Answer: It may seem counterintuitive, but if you have a question about a specific claim, even if it’s related to an NCCI rejection, you should direct it to your assigned Medicare Administrative Contractor (MAC), not an NCCI contractor.

“The NCCI Contractor is able to address general questions and concerns about the NCCI program and edits. Claim-specific inquiries must be directed to the MAC because NCCI edits are implemented by the MACs as part of routine claim processing. This includes appeals of NCCI-related denials,” the Centers for Medicare & Medicaid Services (CMS) reports on its website.

Refresh: CMS established and put into action the NCCI to encourage the uniform and accurate coding of Medicare Part B claims. Its policies are based on coding conventions defined in the AMA CPT^® code book, as well as “national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices,” according to the CMS website. For more information, visit their website at: https://www.cms.gov/.

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC