Part B Insider (Multispecialty) Coding Alert

Published on Thu Mar 20, 2008 PDF

You-ll see the correction in the final CCI version 14.2, but you-ll be able to resubmit problem claims

If you met with denials concerning stress incontinence codes 57287-57288 when your physician also performs a paravaginal defect via an open abdominal approach (57284), then you may need to resubmit these claims, thanks to a Correct Coding Initiative (CCI) error.

Here's what happened: Two CCI edits scheduled for deletion on Jan. 1 did not actually go into effect, says the American College of Obstetricians and Gynecologists (ACOG).

Inadvertently, these deletions had no -deletion date- in the eyes of Medicare claims processing systems and on the CMS Web site.

The deleted edits are listed in the shaded box below.

What you should do: You may hold your claims for the 57287 and 57288 services, which payers would deny if they did not recognize the deleted edits. You can also resubmit these claims after the correction's implementation on July 1. You should receive the additional reimbursement.

-This type of thing happens from time to time when CCI fixes its own error,- says Heather Corcoran with CGH Billing. -But problems can occur when carriers don't pick up on a CCI correction, and then you may have to battle an individual carrier to honor the corrected edit. Keep an eye on your individual Medicare carriers to ensure that they get this right,- she suggests.