2017 CCI Edits to Ensure Revenue Integrity! Presented By: Rachel M. Kaser, BS, CPC, MHSA AHIMA-Approved ICD-10-CM/PCS Trainer Auditor; 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 31st 2nd Quarter: April 1st - June 30th 3rd Quarter: July 1st - September 30th 4th 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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