The National Correct Coding Initiative (NCCI) Edits identify pairs of services that normally should not be billed by the same physician for the same patient on the same date of service. The NCCI Edits were developed for use by the Centers for Medicare and Medicaid Services (CMS) in adjudicating Medicare claims, but they also are used by many private payers and Medicaid agencies. In addition, the NCCI Edits frequently form the basis for proprietary claims software.NCCI Edits contain 1 of 2 types of edits: Mutually Exclusive Edits and Correct Coding Edits (formerly referred to as Comprehensive/Component Edits).Each NCCI code pair is designated with a superscript 0 (zero), 1, or 9. A superscript 0 (zero) appended to a code pair indicates that under no circumstances may a modifier be used to override that edit. Conversely, a superscript 1 appended to a code pair indicates that an appropriate modifier may be used to override the edit. Finally, a superscript 9 indicates that the deletion date of the code pair is the same as the effective date (ie, that particular edit was deleted before ever becoming effective).The NCCI Edits were developed by the CMS to promote correct coding by physicians and ensure appropriate payment for Medicare services. Coding policies used in the creation of the edits are based on Physicians’ Current Procedural Terminology (CPT®) guidelines, national and local Medicare policies, analysis of standard medical and surgical practice, and review of current coding practice. In keeping with CPT guidelines, the NCCI Edits allow override of some edits (ie, those with the superscript 1 appended) with use of the appropriate modifier. Following is a list of modifiers that can be used to override NCCI Edits:For overrides of Mutually Exclusive Edits or Correct Coding Edits, the appropriate modifier always is appended to the code that appears in column 2 because that is considered the bundled procedure. To append the appropriate modifier and override an edit, it is imperative that the conditions of that modifier are met. For example, to append -25 to an E/M code that is part of an NCCI code pair, the E/M service must be significant enough to warrant the separate reporting of that code. The documentation should clearly reflect that, as well. And, again, it should be noted that only NCCI edits designated with superscript 1 are eligible for such overrides.NCCI Edits are released 4 times per year, with each subsequent version replacing its immediate predecessor. Each version ends with either .0 (point zero), .1, .2, or .3. Versions ending in .0 (point zero) are effective from January 1 through March 31 of that year; versions ending in .1 are effective from April 1 through June 30 of that year; versions ending in .2 are effective from July 1 through September 30 of that year; and versions ending in .3 are effective from October 1 through December 31 of that year. For 2003, NCCI is using versions starting with 9. Therefore, the current version is 9.3.Specialty societies, including the American Academy of Pediatrics (AAP), have an opportunity to comment on new NCCI edits as they are proposed by the CMS. While the CMS is not always able to implement revisions based on specialty society comments, NCCI Edits development does allow for an appeals process and remains the only coding edit program that actively encourages input from organized medicine.On September 2, 2003, the CMS released the NCCI Edits free of charge on its Web site (http://www.cms.hhs.gov/physicians/cciedits/default.asp). Previously, they were only available via subscription through the US Department of Commerce. The online NCCI Edits are posted in spreadsheet form, which allows users to sort by procedure code and effective date. There also is a “Find” button that allows users to look for a specific code. The edit files are indexed by procedure code ranges for simplified navigation. The Web site also includes links to the “NCCI Policy Manual for Part B Carriers,” “Medicare Carrier Manual,” and “NCCI Questions and Answers.”For questions on NCCI Edits, please contact Linda Walsh, senior health policy analyst, AAP, at 800/433-9016, ext 7931, or lwalsh@aap.org.