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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https://goo.gl/TVVZ4i