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National Correct Coding Initiative (NCCI) Edits Apply to Indian Health Service (IHS)/Tribal/Urban and Critical Access Hospitals

The Centers for Medicare and Medicaid Services (CMS) developed the NCCI edits to promote national correct coding methodologies. The purpose of NCCI edits is to prevent improper payment when incorrect code combinations are reported. This editing applies to services provided to the same beneficiary, on the same date of service, by the same provider. Reporting both codes will generally result in the denial of payment for one of the services. However, certain code combinations are deemed allowable if the appropriate modifier is reported. In such cases, the patient’s medical record must reflect that the modifier used appropriately describes separate services.

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