We utilize Medicare's National Correct Coding Initiative (NCCI) as the basis for clinical edits. NCCI identifies pairs of services that normally should not be billed by the same physician for the same patient on the same day. NCCI also promotes uniformity among the contractors that process Medicare claims in interpreting Medicare payment policies. We have identified additional code pair edits to be used as a supplement to Medicare's NCCI. These code pair edits were developed using nationally accepted, logical and predictable coding principles. In arriving at these supplemental coding edits, the following were taken into consideration:
- CPT Assistant
- HCPCS manual
- Medicare Part B News
- The CMS Federal Register
- Centers for Medicare & Medicaid Services (CMS)
CPT manual, including code definitions and associated text
Our correct code editor (CCE) is updated quarterly (January, April, July and October). Updates are clearly labeled with the corresponding numbered version of CMS' NCCI.
- January - supplement to NCCI version XX
- April - supplement to NCCI version XX.1
- July - supplement to NCCI version XX.2
October - supplement to NCCI version XX.3
To provide feedback or get clarification about the CCE code pairs, please contact your provider relations representative.