Updates to National Correct Coding Initiative (NCCI)

The Department of Public Welfare (Department) will implement Phase 2 of National Correct Coding Initiative (NCCI) program edits for claims received on or after November 1, 2012. The second phase incorporates Medically Unlikely Edits or procedure code limits as defined by CMS. This phase also includes changes to edit messages. CMS simplified NCCI Procedure-to-Procedure edits by consolidating Incidental code pairs and Mutually Exclusive code pairs into one edit category. For claims received on or after November 1, 2012, the Error Status Codes (ESCs) specific to Incidental coding policies and editing will be the only Procedure-to-Procedure ESCs displayed on a Remittance Advice (RA). Mutually Exclusive specific Error Status Codes (ESCs) will no longer be returned and therefore, will not be displayed on a RA.

A new Error Status Code (ESC) has been created to identify the Medically Unlikely Edit message.