Which statement is TRUE regarding NCCI?

Which statement is TRUE regarding NCCI?

• A. NCCI identifies code pairs and exceptions where a modifier may be used to override the code pair.
• B. NCCI edits identify all code pairs that are permissible to report together under any circumstance.
• C. NCCI edits should not be used in an audit as they are not regulatory information.
• D. NCCI edits identify discrepancies between patient age and diagnosis codes.

Answer: (A)

NCCI focuses on how CPT codes are paired for claims. It creates edits that identify code pairs that should not be reported together on the same encounter unless a justified modifier is used to show that the procedures are separate and billable as distinct services. This is exactly what the statement describes: the system identifies code pairs and the exceptions where a modifier can override the disallowance. The other options misstate what NCCI does—these edits don’t list all permissible pairs under any circumstance, they are regulatory and used in audits, and they don’t address patient age and diagnosis code discrepancies.

NCCI focuses on how CPT codes are paired for claims. It creates edits that identify code pairs that should not be reported together on the same encounter unless a justified modifier is used to show that the procedures are separate and billable as distinct services. This is exactly what the statement describes: the system identifies code pairs and the exceptions where a modifier can override the disallowance. The other options misstate what NCCI does—these edits don’t list all permissible pairs under any circumstance, they are regulatory and used in audits, and they don’t address patient age and diagnosis code discrepancies.