National Correct Coding Initiative (NCCI)

National Correct Coding Initiative (NCCI)

Introduction

Health care providers are responsible few documenting and authenticating legible, complete, and timely patient records in accordance with federal regulations (e.g. Medicare COP) and accrediting agency standards (e.g., The Joint commission). The provider is also responsible for correcting or altering errors in patient record documentation. Health care facilities and physicians' offices usually maintain either manual or automated records, and sometimes maintain a hybrid record. This paper explores the fundamentals behind formation of National Correct Coding Initiative, a brief history, purpose of formation, and implementation structure for Medicaid services.

National Correct Coding Initiative

National Correct Coding Initiative (NCCI) was developed by the Center for Medicare & Medicaid services (CMS) in order to develop national correct coding methodologies (CMS, 2012a). It was developed to ensure proper control of coding information that otherwise would have leaded to payment in Part B claims (CMS, 2012a). These codlings were developed in accordance to the American Medical Association's CPT manual, national societies coding guidelines, national and local policies and edits, current coding practices, and analysis of standard medical and surgical practices (CMS, 2012a). National Correct Coding Initiative Coding Policy Manual for Medicare Services is updated annually by the CMS (CMS, 2012c).

These edits subset have been incorporated in the outpatient code editor (OCE) for therapy providers in order to improve home health agencies (HHAs) billing under TOBs 22X, 23X, 75X, 74X, 34X), comprehensive outpatient rehabilitation facilities (CORFs), and skilled nursing facilities (SNFs) (CMS, 2012b). Main objective of national correct coding initiative formation is to avoid the improper payment structure when incorrect code combinations appear in Medicare services. This Coding Initiative (NCCI) contains two edit tables (CMS, 2012b).  The first edit table is “Column One/Column Two Correct Coding Edits” table; however, the second column is the “Mutually Exclusive Edits” table. Second edit table includes code pairs that must not be reported based on the reasons that are elaborated in the Coding Policy Manual (CMS, 2012c).

For example, the Coding Policy Manual discusses imaging restrictions, such as not reporting Ultrasound guidance for vascular access (Code 76937) in addition to introduction of needle and/or catheter, arterio-venous shunt created for dialysis (Code 36147) (Rowell & Green, 2010). Similarly, CMS highlights that one should not separately report operative angiograms performed as part of interventional vascular procedures using diagnostic codes (Smith, 2010).

Brief History of National Correct Coding Initiative

Health Care Financing Administration (HCFA) assigned a contract to AdminaStar Federal, the Indiana Medicare carrier for defining and developing correct coding practices in 1994 (CMS, 2012b). Corrections in coding practices were required to serve as the standard for national Medicare. Two key concepts evolved from the review of Current Procedural Terminology (CPT) code descriptors, CPT coding instructions, analysis of prevailing and national coding edits, and billing history (Lewis, 2008).

These codlings were forwarded for analysis to Medicare carrier medical directors and physician specialty societies for review and recommendations (Becker, 2009; CMS, 2012c). Final standard national code for Centers for Medicare & Medicaid Services (CMS) was accepted and implemented in ...