Keep pace with the latest CCI edits and be a success

Diet Expert | Sep 18, 2009 | Comments 0

Developed by CMS with an end to promote national correct coding methodologies and do away with improper coding, the Correct Coding Initiative (CCI) edits are used by Medicare and other payors to bundle procedures that should have been billed separately. There are CCI edits for both physician services and hospital outpatient services.

The latest package of CCI edits version, Version 15.3, which will be effective from October 1, 2009 will encompass all previous versions and updates from January 1, 1996, to the present. They are organized in the following tables – Column One /Column Two Correct Coding Edits, and Mutually Exclusive Code (MEC) edits.

To code right, you need to keep pace with the latest CCI codes. Medicare makes its CCI edits available online for free. The decision was taken because previously physicians had to shell out $300 a year for a print version or $260 a year for an electronic version. CMS decided to post the information sensing that it was unfair that physicians had to purchase Medicare’s rules.

Apart from specific CCI codes, the CMS website contains three sections: a policy manual for Medicare Part b carriers, relevant Medicare regulations from the “Medicare Carriers Manual” section 4630; and CCI questions and answers.

Few things that you will do well to know about CCI codes :

You can appeal a payment decision involving a CCI edit.

When clinical circumstances demand, a CPT or HCPCS modifier will override a CCI edit.

CCI coding policies are based on AMA’s CPT manual, national and local policies and edits, coding guidelines developed by national professional societies, etc.

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