September 2003

CMS coding edits on Internet

The Centers for Medicare and Medicaid Services (CMS) has made it easier for physicians and other providers to bill properly and be paid promptly for Medicare. CMS has posted the automated edits it uses to identify questionable claims and to adjust payments on the physicians’ resources page (http://cms.hhs.gov/physicians/cciedits/default.asp) on its Web site.

The edits, known as the National Correct Coding Initiative (NCCI), identify pairs of services that normally should not be billed by the same physician for the same patient on the same day.

Earlier this summer, CMS added a feature to the Web site that makes it possible for physicians to determine in advance payment for services through the Medicare Physician Fee Schedule Look-up (http://cms.hhs.gov/physicians/default.asp).

The NCCI includes two types of edits:

• Comprehensive/component edits — code pairs that should not be billed together because one service inherently includes the other.

• Mutually exclusive edits — code pairs that, for clinical reasons, are unlikely to be performed on the same day.

Source: Centers for Medicare and Medicaid Services, www.cms.gov.

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