Minnesota National Correct Coding Initiative (NCCI)

The Centers for Medicare & Medicaid Services (CMS) implemented the National Correct Coding Initiative (NCCI or CCI) to promote national correct coding methodologies and control improper coding that leads to inappropriate payments. NCCI consists of code pair edits and medically unlikely edits (MUEs).

CCI procedure-to-procedure code pair edits define pairs of Healthcare Common Procedure Coding System (HCPCS) codes (Current Procedural Terminology (CPT) and HCPCS Level II) that should not be reported together except under certain circumstances. The edits are applied to services billed by the same provider for the same patient for the same date of service.
MUEs are unit-of-service edits that define for each HCPCS code, the maximum likely, medically reasonable and necessary number of units of service that would be reported for the vast majority of appropriately reported claims. MUEs are applied to each line of service as rendered by a single provider or supplier to a single patient on the same date of service.

Where can I find CCI edits?
How are CCI code pair edits arranged?
What are CCI associated modifiers?
CCI associated modifiers are:
- Anatomical modifiers: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, RC, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9
- Global surgery modifiers: 25, 58, 78, 79
- Other modifiers: 59, 91, 76 (MUE)
How do I know if a modifier would apply to code pair edits?

Some code pair (column1/column2) edits would never warrant the use of CCI associated modifiers. These code pairs are assigned a correct coding modifier indicator of “0” which means modifiers associated with CCI are not allowed. Modifier indicator “1” means that a CCI associated modifier may be reported if medically appropriate. CCI associated modifiers should NOT be used to bypass a CCI edit unless clinical circumstances justify their use and are documented in the medical record.
When can I use modifier 59?
Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day.

Modifier 59:
- May be used to identify procedures or services that are not normally reported together when performed on the same day by the same physician
- Is used to indicate that two or more procedures are performed at different anatomic sites, or different patient encounters
- Is to be reported only when another modifier does not more appropriately describe the relationship of two or more procedure codes
How are claims adjudicated with MUEs?
How do I report medically reasonable and necessary units of service in excess of the MUE value?

Each line of a claim is adjudicated separately against the MUE value for the code on that line. The appropriate use of modifiers (such as repeat modifier 76; anatomical modifiers such as RT or LT; repeat clinical diagnostic laboratory modifier 91, or distinct procedural modifier 59) to report the same code on separate lines of a claim will enable a provider or supplier to report medically reasonable and necessary units of service in excess of an MUE value.