National Correct Coding Initiative

The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the American Medical Association's CPT manual, 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. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services [1] and may make updates to individual edits quarterly. The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits.

Beginning July 1, 2010, all CMS 1500 claims processed by the Iowa Medicaid Enterprise will be subjected to the editing described in the previous ILs No. 875, 882 and 912, regardless of the date of service.

Any claim processed by Iowa Medicaid where a correct coding edit posts (these are listed on the remittance advice statement) has supplemental edit details available on this portal:

Correct Coding Edit Verification Portlet [2]

Access to the edit detail is as simple as clicking the link and entering the Transaction Control Number (TCN) and billing NPI of the claim.

Informational Letters Concerning CCI:

#875 - Implementation of Correct Coding Initiative and Compliance with CPT, AMA, and National Coding Guidelines Retrospective and Prospective Review of Claims [3]
#882 - Modifier and Payment Policy Updates [4]
#906 - Injection Procedures for Pain Management [5]
#912 - Implementation of National Correct Coding Initiative and Compliance with CPT, AMA, and National Coding Guidelines [6]
#917 - Wound Care [7]
#933 - OB Billing Guidelines for Correct Coding Initiative [8]
#940 - Implementation of Local Coverage Determinations (LCD) and Medicare Medically Unlikely Edits (MUE) Editing [9]
#941 - Implementation of National Correct Coding Initiative (NCCI) and Compliance with CPT, AMA, and National Coding Guidelines [10]
#944 - Properly Declaring Units of Service for a Given Date [11]
#955 - TCM - Properly Declaring Units of Service for a Given Date [12]
#956 - Billing Multiple Units [13]
#966 - Duplicate Claim Submissions [14]

Links to Tools and Resources:

IME "U" Modifier Definitions & Instructions [15]
IME Modifier Definitions & Instructions [16]
Correct Coding Edits FAQ [17]
MMM Global Surgery Days [18]
YYY Global Surgery Days [19]
User Guide - Portlet for Correct Coding Edit Verification [20]
Rule - Category Descriptions [21]
Maternity Billing Guidelines [22](9/01/2010)
NCD Editing -- List of Additional Diagnoses Accepted by IME [23]
Local Coverage Determinations (LCD) Utilized by IME [24] (09-02-2010)
Nutrition Therapy [25]

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