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NCCI Coding Edits

Since 1996 the Medicare NCCI procedure to procedure edits have been assigned to either the Column One/Column Two Correct Coding edit file or the Mutually Exclusive edit file based on the criterion for each edit.  The Mutually Exclusive edit file included edits where two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations.  All other edits were assigned to the Column One/Column Two Correct Coding edit file.  There are important upcoming changes to these files described below. 

In order to simplify the use of NCCI edit files, CMS will consolidate the two edit files into the Column One/Column Two Correct Coding edit file.  Separate consolidations will occur for the two practitioner NCCI edit files and the two NCCI edit files used for OCE.  This change will occur for practitioner NCCI edits in NCCI version 18.1 scheduled for April 1, 2012.  After these changes occur, it will only be necessary to search the Column One/Column Two Correct Coding edit file for active or previously deleted edits.  Effective April 1, 2012, CMS will no longer publish a Mutually Exclusive edit file on its website for either practitioner or outpatient hospital services since all active and deleted edits will appear in the single Column One/Column Two Correct Coding edit file on each website.  The edits previously contained in the Mutually Exclusive edit file are NOT being deleted but are being moved to the Column One/Column Two Correct Coding edit file. 

Practitioner NCCI - In NCCI version 18.1 for practitioners scheduled for April 1, 2012, all edits in the Mutually Exclusive edit file will be moved to the Column One/Column Two Correct Coding edit file with the same implementation and, if relevant, deletion date as the edits have in the mutually exclusive edit file.  These edits are not being deleted from NCCI but are being moved to the Column One/Column Two Correct Coding edit file.  The net result will be that the NCCI version 18.1 Column One/Column Two Correct Coding edit file will contain all active NCCI edits and deleted NCCI edits that previously were contained in the Mutually Exclusive and Column One/Column Two Correct Coding edit files.  The CMS website will have a single Column One/Column Two Correct Coding edit file for practitioner NCCI.

Outpatient NCCI used in OCE - Effective April 1, 2012 the change will be implemented on the CMS website where a single Column One/Column Two Correct Coding edit file will appear which will contain all active NCCI edits and deleted NCCI edits that previously were contained in the OPPS Mutually Exclusive and Column One/Column Two Correct Coding edit files.  These edits are not being deleted from the OCE NCCI files but are being moved to the Column One/Column Two Correct Coding edit file. 

 


UPDATE:  As of October 8, 2014, the NCCI text files have been modified for 508 compliancy purposes.  They now include headers and are tab delimited.

NOTICE:  For the first quarter of 2015, additional hospital and physician NCCI edit files have been provided which contain an edit rationale column.   These files, labeled as “NTIS format” are formatted to match the files previously supplied by NTIS.  For the January, 2015 release the structure of the current NCCI edit data files will remain unchanged and both versions will be posted.  However, these two files structures will be consolidated into a single format for future releases.

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