The Centers for Medicare & Medicaid Services (CMS) released the quarterly National Correct Coding Initiative (NCCI) edit updates for July. The mandatory NCCI edits were initially incorporated into the Medi-Cal claims processing system on March 28, 2011 for dates of service retroactive to October 1, 2010. CMS updates the edits every quarter. These latest updates will be applied to claims for dates of service beginning July 1, 2011. The Medi-Cal claims processing system already applies many of the same edits to claims as NCCI. However, it is expected that the NCCI edits will further impact reimbursement for some claims.

NCCI edits are designed to prevent inappropriate reimbursement of services including, but not limited to services that are:

• Mutually exclusive
• Inappropriately bundled (a comprehensive service billed with a component service)
• Billed with too many units of service (medically unlikely)

Information released by Medi-Cal about NCCI is supplemental only. Providers must use the CMS website (NCCI Edits Overview) as their primary source of NCCI information. Additional NCCI information is available as follows:

• ZIP (compressed) files showing NCCI edits (CMS website)
• Charts showing NCCI-related edits, including Medically Unlikely Edits (MUEs) and column 1/column 2 edits for HCPCS Level II codes (Back of the 2011 HCPCS code book)
• Medi-Cal NCCI website
• New NCCI-focused Medi-Cal provider manual section, Correct Coding Initiative: National
• Telephone Service Center at 1-800-541-5555