The National Correct Coding Initiative (NCCI) was developed by the Centers for Medicare and Medicaid Services (CMS) to eliminate improper CPT coding, detect inappropriate CPT codes on claims and deny payment for them. NCCI edits are released 4 times a year.

Significant to NCCI is the term “Mutually Exclusive.” Mutually exclusive procedures are those procedures that cannot reasonably be performed together based on the code definitions or anatomic considerations. Therefore, Mutually Exclusive Edits are used to indicate one of three things:

1. the two codes cannot reasonably be done in the same session;

2. situations where two procedures representing two different methods to accomplish the same therapeutic result may have been employed and only the successful procedure should be reported; or

3. the reporting of an initial and a subsequent service together.

An advanced clinical coder/billing specialist must have knowledge of NCCI and NCCI edits.

Explore best practices from The National Correct Coding Initiative (NCCI).

Include the following aspects in the discussion:

· In your own words describe NCCI, its history, purpose, and importance in correcting coding

· What are the policies based on?

· How would you use this in your daily coding/billing activities?

· Discuss what the benefits are of NCCI and NCCI edit.

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