Look for Corrections to CCI Version 6.1 Edits

Due to a large number of errors, the implementation of the national Correct Coding Initiative (CCI) version 6.1 was delayed from April 1 to May 1. Users of any CCI edit products should make certain that they have a corrected copy of version 6.1, either in the form of an errata sheet or, in some cases, an updated book, says Laurie Castillo, MA, CPC, president of American Association of Professional Coders (AAPC) northern Virginia chapter and owner of Physician Coding & Compliance Consulting in Manassas, Va.

The National Technical Information Service (NTIS) publishes the CCI edits, along with several other commercial resellers who purchase the raw data from NTIS. According to an NTIS spokesperson, all of their customers received an errata sheet soon after NTIS was made aware of the errors by the Health Care Financing Administration (HCFA). We received 37 pages of changes from NTIS, confirms Tony Mistretta of the Medical Management Institute, one of the licensed resellers of the CCI edits. We have committed to making all the changes to the book by hand and sending out corrected manuals to our subscribers.

Those who purchased CCI edits from another source also should look for corrections to version 6.1. For NTIS customers, this has been sent out in the form of an appendix, which must be cross-referenced to the version 6.1 product. Other resellers should have received the errata sheet from NTIS and made arrangements to get that information to their customers.

Background

In response to direction from Congress, CCI edits were initiated in 1996 to reduce Medicare program expenditures by detecting inappropriate coding on claims and denying payment. The CCI edits are basically a list of code pairs that Medicare will not reimburse together for the same patient on the same day because they represent services that are bundled or would not ordinarily be performed together, states Castillo.

Reporting two of these codes together for the same service represents fraudulent unbundling, which is the practice of breaking down a single procedure into its component parts and billing for additional services, Castillo warns.

There are times, however, when two of these codes might legitimately be coded together, if they represent two services that are distinct and independent from each other, declares Castillo. To indicate that the codes represent separate services as opposed to unbundling of a single service, coders should use appropriate modifiers, such as CPT modifier -59 (distinct procedural service).

Correct Coding Modifier 0 and 1

The CCI edits list code pairs that are excluded based on two relationships:
1) one code is comprehensive and includes the service of the other, component code; or

2) the two codes are mutually exclusive, such as two different lab tests that measure the same factor.

Within the list [...]

- Published on 2000-06-01