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Denials Due to NCCI Edits

Coding Advisor National Correct Coding Initiative NCCI edits Unbundling error

What the heck is an NCCI edit, and why should you care?

NCCI stands for "National Correct Coding Initiative," which is a project from the CMS to make medical coding more accurate. Or maybe to confuse medical coders.

The point of an NCCI edit is to make sure the claim doesn’t itemize components of a procedure that are all included under one procedure code. Think of it this way: If a surgeon performs an appendectomy, she can't bill for opening the patient up, and also bill for the removal of the appendix, and also bill for closing the patient. That's all included by the CPT code for an appendectomy (44950), and violating that rule is called an "unbundling error."

When you buy a house, you don't get charged for each individual brick. You pay for the whole house.

The Coding Advisor automatically checks for NCCI edits to make sure your claim won't be denied. It can even help you fix the problem under certain circumstances. We will talk more about NCCI edits in a future blog post because they are more subtle than what we've described in this post.

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