National Correct Coding Initiative

The National Correct Coding Initiative (NCCI) is a Centers for Medicare & Medicaid Services (CMS) program designed to prevent improper payment of procedures that should not be submitted together. There are two categories of edits: Both the physician and outpatient edits can be split into two further code pair categories: NCCI code pairs must match on member, provider, and date of service. CMS maintains tables of code pair edits and updates these tables on a quarterly basis.
 * Physician Edits: these code pair edits apply to physicians, non-physician practitioners, and Ambulatory Surgery Centers
 * Hospital Outpatient Prospective Payment System Edits (Outpatient Edits): these edits apply to the following types of bills: Hospitals (12X and 13X), Skilled Nursing Facilities (22X and 23X), Home Health Agencies Part B (34X), Outpatient Physical Therapy and Speech Language Pathology Providers (74X), and Comprehensive Outpatient Rehabilitation Facilities (75X).
 * Column1/Column2 Code Pairs: these code pairs were created to identify unbundled services. The name is derived from the fact that the code pairs are separated into two columns; Column 1 contains the most comprehensive code, and Column 2 contains component services already covered by that more comprehensive code. These code pairs are further categorized into two sets:
 * Modifier: the appropriate use of a modifier allows these code pair to be reported together. In most cases, the -59 modifier is used, although there are other acceptable modifiers. These modifiers must be supported by documentation in the medical record.
 * No Modifiers: these code pairs should never be reported together, regardless of modifiers.
 * Mutually Exclusive Code Pairs (MEC): these code pairs should not be reported together because they are mutually exclusive of each other.