The National Correct Coding Initiative (NCCI) edits are updated quarterly and the institutional version is one calendar quarter behind the physician version. In the past, the outpatient code editor (OCE) has not applied the NCCI edits for the following categories of services: Anesthesiology, evaluation and management, and mental health services.

Effective January 1, 2009, these categorical exclusions will be removed, and there will be a large number of new institutional NCCI edits applied to claims. These institutional NCCI edits will be available on or about January 1, 2009, on the CMS Web site at http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEHOPPS/list.asp#TopOfPage .

To review the types of NCCI edits that were previously excluded from the institutional version but are currently included in the physician version for these categories, refer to the NCCI files on the following Web site at http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage .

You may use anesthesiology, evaluation and management, or mental health services CPT or Level II HCPCS codes to search these files. A subset of the corresponding edits in the physician version is being added to the institutional version. Consistent with longstanding practice, CMS makes specific decisions about NCCI edits that are appropriate for facilities, incorporating comments on potential edits from relevant professional associations. Therefore, the institutional NCCI edits may differ from the physician NCCI edits.

Affected providers should begin immediately to educate their staff about the application of the additional categories of NCCI edits to their claims. Note that at this time, no additional providers will be subject to NCCI edits.