Which CMS initiative is designed to detect inappropriate coding and ensure proper code use?

Which CMS initiative is designed to detect inappropriate coding and ensure proper code use?

• A. National Correct Code Initiative (NCCI)
• B. HIPAA
• C. ICD-10-CM
• D. CPT Editorial Panel

Answer: (A)

The testing focus here is on a CMS program that actively limits improper billing by checking how codes are used together. The National Correct Coding Initiative is designed for this purpose. It publishes edits that flag or deny certain CPT/HCPCS code pairings when billed on the same claim line unless a legitimate medical justification or a specific modifier is applied. This helps prevent improper payments and promotes proper coding practices across Medicare and many other payers. Unlike HIPAA, which governs privacy and data standardization, or ICD-10-CM, which is a diagnosis coding system, or the CPT Editorial Panel, which develops CPT codes, this CMS initiative specifically targets the correctness of code pair usage and billing practices.

The testing focus here is on a CMS program that actively limits improper billing by checking how codes are used together. The National Correct Coding Initiative is designed for this purpose. It publishes edits that flag or deny certain CPT/HCPCS code pairings when billed on the same claim line unless a legitimate medical justification or a specific modifier is applied. This helps prevent improper payments and promotes proper coding practices across Medicare and many other payers. Unlike HIPAA, which governs privacy and data standardization, or ICD-10-CM, which is a diagnosis coding system, or the CPT Editorial Panel, which develops CPT codes, this CMS initiative specifically targets the correctness of code pair usage and billing practices.