Medical coding or medical classification is defined as the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers.
What is the NCCI and its purpose? NCCI refers to National Correct Coding Initiative. It was the CMS (Centers for Medicare and Medicaid Services) that developed the National Correct Coding Initiative (NCCI) with the objective of promoting National correct coding methodologies and also to control improper coding that leads to wrong payments in Part B claims. There has indeed been a lot of wrong payments made in the medical billing and claim sector in the US and medical claim frauds that run into millions have been reported. Hence having a perfect medical claim demands a well defined medical system and procedures with specific and clear medical codes for every single process. This is obviously the root for all correct medical coding initiatives.
What are the CMS policies developed from? They include,
Coding conventions from CPT manual, National and local policies / edits Coding guidelines developed by national societies Analysis of standard medical and surgical practices Review of current coding practices.
What are CCI (Correct coding Initiative) edits? It refers to pairs of Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Level II codes that are not separately payable except under specific circumstances. The edits are applied to services billed by the same provider for the same beneficiary on the same date of service. All claims are processed against the CCI tables. National Correct Coding Initiative Edits are categorized separately for various Physicians and also for outpatients. The CCI edits are part of the Outpatient Code Editor (OCE) that determines payment for hospital Outpatient Prospective Payment System (OPPS) services. The Outpatient Code Editor (OCE) does not include CCI edits for the following: anesthesiology, evaluation & management, and mental health services.
Every year the CMS updates the Coding Policy Manual for Medicare. It is used as a general reference by the Medicare Carriers and Fiscal Intermediaries (FIs). The CMS Online Manual System is used by CMS program components, partners, contractors, and State Survey Agencies to administer CMS programs. It offers day-to-day operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. For specific NCCI edits, one may submit comments in writing to:
National Correct Coding Initiative
Correct Coding Solutions LLC
P.O. Box 907
Carmel, IN 46082-0907
The NCCI Edits Manual may also be obtained by purchasing the manual, or sections of the manual, from the official National Technical Information Service (NTIS) website, or by contacting NTIS at 1-800-363-2068 or 703-605-6060.
|
