What are "code edit pairs" that cannot be reported on the same claim for payment referred to as?

Code edit pairs that cannot be reported on the same claim for payment are referred to as the National Correct Coding Initiative (NCCI). The NCCI was developed by the Centers for Medicare & Medicaid Services (CMS) to promote correct coding methodologies and eliminate inappropriate payment for misreported services. It does this by identifying pairs of codes that should not be billed together due to their relationship, meaning that one service includes the other or they cannot be performed together.

This initiative helps mitigate issues such as fraud and abuse in billing, ensures proper reimbursement, and promotes the efficient use of healthcare resources. This is crucial for maintaining the integrity of the coding and billing process within the healthcare system.

The other terms listed, while related to claims and payments, do not specifically refer to the coding pairs that the NCCI addresses. For instance, rejection codes and claim denial rules typically involve the processing and potential refusal of a claim for other reasons, while bundled services refer to the grouping of related procedures into a single payment, rather than specifically discussing fundamental coding relationships.