Accurate medical coding is the foundation of any successful revenue cycle—and yet, many providers still face denials and delays due to incorrect code combinations. That’s where NCCI edits come in.
The National Correct Coding Initiative (NCCI) was created by the Centers for Medicare & Medicaid Services (CMS) to promote accurate billing and coding practices, prevent improper payments, and ensure compliance with federal regulations.
NCCI edits are automated rules that evaluate code combinations on a claim to prevent improper billing. They are applied to Medicare Part B and Medicaid claims to ensure that services are coded correctly and not billed more than once when they shouldn’t be.
These edits fall into two main categories:
PTP edits prevent providers from billing for two procedures that shouldn’t be reported together. For example, if one code already includes the work of the other, billing both would be considered duplicative.
MUEs set limits on the number of times a particular service can be billed for a patient on the same day. They are designed to flag overutilization, prevent potential fraud, and reduce coding mistakes.
Failing to follow NCCI guidelines can lead to claim denials, audits, and even financial penalties. On the flip side, properly applying NCCI edits benefits your practice in several key ways:
Avoid billing for services that should be bundled together or shouldn’t be billed in combination.
Catch errors before submission to avoid costly resubmissions or appeals.
Stay aligned with Medicare and Medicaid rules and reduce your audit risk.
Help reduce inappropriate billing, which protects healthcare dollars and reduces financial waste.
If you're involved in the revenue cycle, NCCI edits should be on your radar:
Let’s say a provider performs an excision of a benign skin lesion and bills:
If these procedures are performed on the same site, the PTP edit will trigger a denial for 10060 unless the provider includes a modifier (like Modifier 59) to indicate the procedures were separate and distinct.
Without the edit, both codes might be paid in error—leading to overpayment and compliance issues. With NCCI edits, only the appropriate service is reimbursed.
Features include:
NCCI edits are not just guidelines—they’re essential tools for ensuring compliance, protecting revenue, and running an efficient practice.
With the complexity of coding constantly evolving, automation is no longer a luxury—it’s a necessity. By embedding NCCI edit support into your medical coding process, you're not just avoiding denials—you’re building a stronger, smarter revenue cycle.
MediMobile supports NCCI edits automatically, helping you stay compliant and get paid faster—without extra manual work.
👉 Schedule a demo below on our calendar to begin coding smarter: