Why Auditors Need to Know Everything About NCCI & Unbundling (Modifier 59)

The National Correct Coding Initiative (NCCI) is a program designed by the Centers for Medicare and Medicaid Services to prevent overpayment or improper payment of procedures that should not be submitted together.

Providers may look at NCCI edits and regulations as purely punitive and designed to impair their reimbursement. However, as coders and auditors, we know the NCCI edits’ true purpose: to establish a uniform coding review method and control unnecessary expenditures so that governmental funding can remain available to qualifying beneficiaries. And it’s our responsibility to explain it to providers.

Usually, upon clear and logical explanation of the reasons for correct coding edits, providers can relate this logic to their clinical practice and appreciate the standardization. That’s why it’s so important for us, as their compliance support professionals, to be familiar with all aspects of NCCI. Only when we remain current in our knowledge can we help maintain accurate billing and coding practices.

Get your free eBrief, Your Essential Guide to the National Correct Coding Initiative, to get a thorough overview of edits. In this eBrief, you’ll learn about edit categories and important subclassifications of edits, edits for mutually exclusive procedures and sequential procedures, and myriad ways that edits maintain accurate billing and coding practices.