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National Correct Coding Initiative (NCCI) Edits Overview
The NCCI edits were developed in order to create a standarised set of coding patterns and groupings. When entering service codes as part of the patient bill, the submitted procedures should be reported with the CPT/HCPCS codes that most comprehensively describe the services performed. The edits are designed to identify either accidental or deliberate 'unbundling' of a comprehensive code into several component parts in order to increase reimbursement.

Fines of $10,000 per incident can be levied in circumstances where fraud is suspected.

The files come with two columns and contain:

-a pair of codes, in a first (Column 1) or second (Column 2) field
-identifier that notes if a code pair cannot be billed together under any circumstances or if use of an appropriate modifier allows billing of a code pair
-start date for all edits, and an end date for retired edits
-the administrative explanation for the edit pair

There are over 125,000 active edits plus another 225,000 retired edits for a total of over 350,000 edits.

Here are examples from the NCCI manual of unbundling that the edits are designed to identify and reject:


-Fragmenting one service into component parts and coding each component part as if it were a separate service. For example the correct CPT comprehensive code to use for upper gastrointestinal endoscopy with biopsy of stomach is CPT code 43239. Separating the service into two component parts, using CPT code 43235 for upper gastrointestinal endoscopy and CPT code 43600 for biopsy of stomach is inappropriate.

-Reporting separate codes for related services when one comprehensive code includes all related services. An example of this type is coding a total abdominal hysterectomy with or without removal of tubes, with or without removal of ovaries (CPT code 58150) plus salpingectomy (CPT code 58700) plus oophorectomy (CPT code 58940) rather than using the comprehensive CPT code 58150 for all three related services.

-Breaking out bilateral procedures when one code is appropriate. For example, bilateral mammography is coded correctly using CPT code 76091 rather than incorrectly submitting CPT code 76090-RT for right mammography and CPT code 76090-LT for left mammography.

-Downcoding a service in order to use an additional code when one higher level, more comprehensive code is appropriate. A laboratory should bill CPT code 80048,(Basic metabolic panel), when coding for a calcium, carbon dioxide, chloride, creatinine, glucose, potassium, sodium, and urea nitrogen performed as automated multichannel tests. It would be inappropriate to report CPT codes 82310, 82374, 82435, 82565, 82947, 84132, 84295 and/or 84520 in addition to the CPT code 80048 unless one of these laboratory tests was performed at a different time of day to obtain follow-up results, in which case a modifier –91 would be utilized.

Separating a surgical approach from a major surgical service. For example, a provider should not bill CPT code 49000 for exploratory laparotomy and CPT code 44150 for total abdominal colectomy for the same operation because the exploration of the surgical field is included in the CPT code 44150.


The manual is updated each October. Click here for a zip file that contains the manual in Word format.

Flash Code allows quick analysis of these edits through:

1. CCI Quick Check
2. CCI column display of edits for any affected code
3. CCI edit checks on 2 or more codes at a time via Flash Code's Validation Engine