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NCCI Procedure to Procedure (PTP) edits were established to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits

NCCI Procedure to Procedure (PTP) edits were established to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits for physicians or practitioners and one table of edits for outpatient hospital services. The purpose of the NCCI Medically Unlikely Edits (MUE) program is to prevent improper payments when services are reported with incorrect units of service.

Part I.

  1. Go to CMS website link: https://www.cms.gov/medicare-medicaid-coordination/national-correct-coding-initiative-ncci/ncci-medicareLinks to an external site.
  2. Go to replacement files: Click on https://www.cms.gov/medicare-medicaid-coordination/national-correct-coding-initiative-ncci/ncci-medicare/medicare-ncci-procedure-procedure-ptp-editsLinks to an external site.
  3. Go to Related Downloads and Review each Hospital PTP Edits
  4. Open the file and select 5 CPT codes from column 1
  5. Also, list the CPT codes that are allowed and not allowed from column 2

Part II.

  1. Define Medicare National Correct Coding Initiative (NCCI) Edits
  2. What did you learn about NCCI edits and how would these edits be beneficial for a HIM Professional?

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