Wiki What is the inpatient equivalent to NCCI?

[Bombinat]

What is the inpatient equivalent to the National Correct Coding Initiative edits? The CMS site advises that NCCI applies to Part B only. What are the name of the edits that apply to Part A - inpatient hospital?

Alexandra

 

[ellzeycoding]

There is a hospital-NCCI listing available on the CMS site.

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

 

[thomas7331]

There aren't any inpatient/Part A equivalents to NCCI. Inpatient hospital claims are paid based on DRGs which are determined by ICD-10 diagnosis and PCS codes and other factors such as patient age and length of stay. Since the claims are not coded with CPT codes and not reimbursed on a fee schedule, there are no corresponding coding or bundling edits. There are hospital NCCI edits, as per the post above, that apply to outpatient hospital claims - these are mostly the same as the physician NCCI edits and follow generally the same rules.

 

[ellzeycoding]

Thanks for the clarification Thomas. I don't use that listing, so I've never known what they were for.