National Correct Coding Initiative enables better reporting of multiple services

September 1, 2009

It is imperative, especially in uncertain economic times, for physicians to be thoroughly familiar with Medicare's National Correct Coding Initiative (NCCI). This initiative was put forth in 1996 in order to promote correct coding and to serve as a ready mechanism by which to reduce improper coding.

Key Points

The core of the program, from the physician's perspective, is the set of tables that list various current procedural terminology (CPT) code combinations. Codes that appear together in the tables either may not be used together or may be used together only under certain conditions. Such codes are known as bundled codes.

These tables are dynamic (changing every quarter) and typically contain many additions and deletions compared with previous versions. It is important that you and your office staff use the most current copy of the NCCI available. These are available free at the CMS Web site: http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage/.

Mutually exclusive codes

One set of tables is known as the "mutually exclusive" tables. Codes that appear together in this table cannot in theory be performed together. An example of a code pair appearing in the mutually exclusive table is CPT 68810, Excision of lesion, conjunctiva; up to 1 cm, and CPT 68815, Excision of lesion, conjunctiva; over 1 cm. It would be impossible for a single lesion to fall into each of these categories; therefore the codes are considered mutually exclusive. Another code pair that falls in this category is CPT 66170, Trabeculectomy in absence of previous surgery, and CPT 66172, Trabeculectomy with scarring from previous surgery.