Date post: | 12-Apr-2017 |
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Health & Medicine |
Upload: | supercoder-llc |
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2017 CCI Edits to Ensure Revenue Integrity!
Presented By:Rachel M. Kaser, BS, CPC, MHSA
AHIMA-Approved ICD-10-CM/PCS TrainerAuditor; SuperCoder.com
Course Objectives
• Definition of CCI Edits and their importance
• Detailed explanation of 2017 edits
• Understanding modifiers for CCI edits
• Review of CCI policy manual changes effective January 1, 2017
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CCI and NCCI Edits: Basic Overview
• National Correct Coding Initiative (NCCI)
• Correct Coding Initiative (CCI)
• Created by CMS to “promote national correct coding methodologies and to control improper coding leading to inappropriate payments on Part B claims.”
• www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
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National Correct Coding Initiative (CCI)
• Implemented by CMS
• Promotes correct coding methodologies
• Controls the improper assignment of codes that results in inappropriate reimbursement
Medicare Publishes CCI:
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
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National Correct Coding Initiative (NCCI)
• Additions/revisions to the manual have been italicized in red font
• NCCI Procedure-to-Procedure(PTP); January 1, 1996 and began implementing Medically Unlikely (MUE) edits on January 1, 2007
• A corresponding set of PTP edits is incorporated into the outpatient code editor (OCE) for OPPS and therapy providers
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2017 Edition of Correct Coding Initiative (CCI) Edits, Version 23.0
• Version 23.0: Effective for claims filed on or after January 1, 2017
• Organized in Two Tables:• Column 1 / Column 2 Correct Coding Edits
• Mutually Exclusive Code (MEC) Edits
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2017 Edition of Correct Coding Initiative (CCI) Edits, Version 23.0 • Updated Quarterly:
• 1st Quarter: January 1st - March 31st2nd Quarter: April 1st - June 30th3rd Quarter: July 1st - September 30th4th Quarter: October 1st - December 31st
• Deleted effective January 1, 2017
• Take a look at those to ensure your practice is aware of the changes to ensure efficient and clean submission of claims
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2017 Edition of Correct Coding Initiative (CCI) Edits, Version 23.0
• The spreadsheet shows 99,490 CCI edit additions for January 1, 2017!
• Additions emphasize Spinal Injections and Moderate Sedation
• Additions of bundling for the integumentary system codes into new surgical procedure codes
• Bundling of radiology codes into new codes that specifically include imaging guidance
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2017 Edition of Correct Coding Initiative (CCI) Edits, Version 23.0
• Deletions: 55,760
• The deletions remove edits for 62310-62319 (which 62320-62327 replace) and 99143-99150 (which 99151-99157 replace)
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2017 Edition of Correct Coding Initiative (CCI) Edits, Version 23.0
Always Check the Modifier Indicator Changes:
• The tab showing modifier indicator changes is an important one because it shows existing edits that have new reporting rules
• You’ll see which edits have been changed from modifier indicator 0 to modifier indicator 1 and vice versa
• Ensure you check the individual edits before making any final coding decisions
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2017 Edition of Correct Coding Initiative (CCI) Edits, Version 23.0 • Change from 0 to 1 (may override):
• Edits bundling paravertebral block codes 64461 and 64463 into trigger point injection codes 20552 and 20553
• Edits bundling A95xx radiopharmaceutical codes into certain 783xx and 788xx nuclear medicine codes
• Edits bundling 95941 and G0453 (intraoperative neurophysiology monitoring from outside the OR) into 95940 (intraoperative neurophysiology monitoring from inside the OR)
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