NCCI Edits (Unbundling) Overview

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The NCCI edits have been developed in order to help medicare contain costs by identifying UNBUNDLING. The current edits include over 950,000 pairs of codes.

WHAT IS UNBUNDLING? Unbundling consists of the billing of multiple component procedures when a comprehensive procedure could be billed instead.

The total submitted charges for the multiple component procedures is greater than the single charge for the comprehensive (all inclusive) procedure.

One way to think of it is as follows:

The "Dinner" meal at a local restaurant costs $20 and includes the following five items:

    -Soup

    -Salad

    -Beverage

    -Entree

    -Dessert

These five items can be ordered a-la-carte (separately) at a cost of $5 each. The same food, billed at a-la-carte pricing would cost $25, which is $5 more than the "dinner" meal.

In NCCI terms, Comprehensive codes are "dinner" meals, Component (unbundled) codes are "a-la-carte" items.

Deliberate billing of unbundled codes is classified as fraudulent and carries a $10,000 per incident fine.

Flash Code provides access to all current and recent edits (the past four years) through:

-Column views of all edits that affect individual codes

-Our CCI Quick Check which allows you to enter any two codes to check for unbundling

-The Flash Code Analysis Engine, which analyzes groups of codes for unbundling