How to Look Up NCCI Workers Compensation Class Codes Programmatically

How to Look Up NCCI Workers Compensation Class Codes Programmatically Every medical claim submitted to Medicare goes through the National Correct Coding Initiative (NCCI) edit system before payment is approved. CMS publishes tens of thousands of Procedure-to-Procedure (PTP) edits and Medically Unlikely Edits (MUE) that define which CPT/HCPCS code pairs can be billed together and how many units of a given code are reasonable per encounter. If your billing system does not check claims against these edits before submission, you are going to get denials. This article explains what NCCI edits are, how PTP bundling and MUE limits work, and how to validate claims programmatically. What are NCCI edits The NCCI was established by CMS in 1996 to promote correct coding and prevent improper payment for Medicare Part B claims. There are two types of edits: PTP (Procedure-to-Procedure) edits define pairs of CPT/HCPCS codes that should not normally be billed together on the same claim. One code in th