The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150, [email protected]Take the Initiative to Keep Your ENT Coding Correct with CCI Edits By Susan Dooley More than 57,000 National Correct Coding Initiative (NCCI) edits went into effect on January 1—that’s a lot to keep up with! The National Correct Coding Initiative —CMS’s Way of Promoting Coding Accuracy As you know, HHS implemented the Medicare National Correct Coding Initiative (NCCI, also known as CCI) to control improper coding that can lead to inappropriate payment. NCCI Procedure -to-Procedure (PTP) code pair edits, which are ofte n called edit pairs, automate prepayment edits when ce rtain codes are submitted together for services covered by Medicare Part B. The pairs are presented in columns that remind me of old-time Chinese restaurant menus where you choose one combination platter item from Column 1 and another from Column 2. In the case of CCI edit pairs, the Column 1 code represents the more significant procedure or service when reported with the Column 2 code. Column 1 codes usually have a higher work relative value unit (RVU) than do the column 2 codes.
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7/24/2019 Take the Initiative to Keep Your ENT Coding Correct With CCI Edits
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,[email protected]
Take the Initiative to Keep Your ENT CodingCorrect with CCI Edits
By Susan Dooley
More than 57,000 National Correct Coding Initiative (NCCI) edits went into effect on January 1 —that’s alot to keep up with!
The National Correct Coding Initiative — CMS’s Way of PromotingCoding Accuracy
As you know, HHS implemented the Medicare National Correct Coding Initiative (NCCI, also known asCCI) to control improper coding that can lead to inappropriate payment. NCCI Procedure-to-Procedure
(PTP) code pair edits, which are often called edit pairs, automate prepayment edits when certain codesare submitted together for services covered by Medicare Part B. The pairs are presented in columns thatremind me of old-time Chinese restaurant menus where you choose one combination platter item fromColumn 1 and another from Column 2.
In the case of CCI edit pairs, the Column 1 code represents the more significant procedure or servicewhen reported with the Column 2 code. Column 1 codes usually have a higher work relative value unit(RVU) than do the column 2 codes.
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,[email protected]
Caloric Vestibular Tests Can Make Your Head Spin
The first time I heard the term “ice water calorics,” I couldn’t figure out how ice water could havecalories. Imagine how dumb I felt when I learned that here, calorie referred only to heat, not howfattening a piece of cake was. This test looks for the presence of nerve damage in the ears using cold orwarm water or air.
It turns out that caloric vestibular tests are common enough to be included in CCI edit pairs. The twofollowing CPT® codes are Column 1 codes when performed with several specific procedures.
95357, Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one coolirrigation in each ear for a total of four irrigations)
95358, Caloric vestibular test with r ecording, bilateral; monothermal (ie, … for a total of twoirrigations)
You’ll file claims using the appropriate choice of the above two rather than one of the following.
69209, Removal impacted cerumen using irrigation/lavage, unilateral 69210, Removal impacted cerumen requiring instrumentation, unilateral G0268, Removal of impacted cerumen (one or both ears) by physician on same date of service
as audiologic function testing
ENT coding experts explain that these edits involving 69209, 69210, and G0268 came about becauseCMS didn’t want to pay for the removal of cerumen that gains access to the ear canal for vestibulartesting as well as paying for the testing itself. For that reason, Medicare reimburses providers for thetest only when cerumen must be removed to perform it. (Of course, if your provider is just removingimpacted ear wax and not trying to perform any tests, 69209 or 69210 are perfectly acceptable.)
How About You?
Got any tips for dealing with CCI edits? Let us know .
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