what do CCI edits mean??

Rncoder

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:confused: This is a basic question but i do not fully understand what cci edits are telling me when i look them up. When i look up a cpt code and there are cci edits in column 2 ..does that mean you can NOT use those codes in column 2 with that cpt code?? thanks:p
 

kbarron

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CCI Edits

It stands for Correct Coding Initiative. I am not sure what you are looking at, but I have some coding books that tell me what codes I cannot use together. Hopes this helps.
 

mmelcam

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It would depend. If the code in column 2 has a 0 next to it, then no you can not bill those codes together. If it has a 1 next to it, then you can bill them together with a modifier (that is of course if it meets the guidelines for the modifier you choose). In the front of the CCI edit book it will explain everything under the General Correct Coding Policies. Read this over and you will better understand.
 
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Hi,

CCI means "Correct Coding Initiative" and they are contained in the CCI Edits Handbook. You can find it online via an excel format on the CMS website or you can subscribe to the written texts that are for sale.

Basically there are 2 colums which contain cpt codes. Column 1 is your main code/procedure and when you want to bill another service with it, you can look up to see if doing so would "unbundle" the 2 services. Column 2 shows all the codes that are considered "components" of the main code found in Column 1.

For example, look up code 99213 in Column 1. Next to it will be a large number of cpt codes - all the codes that are considered "bundled" into the 99213. There is a third colum which show "indicators" - (0) means that there is no way that any payor would allow payment or billing of the combination of codes found in that row, there is no modifier you can add, there is no documentation you can send, etc. Basically, the two codes are not billable together. An indicator of (1) means that a modifier can be appended to the cpt code in Column 2 to allow it to be unbundled and therefore considered separately for payment. Remember that the modifier goes on the cpt code in Column 2. Typically, this modifier is (-59).

Lastly, there is a grouping called "Mutually Exclusive" codes. These are cpt codes that are inherently considered components of each other and therefore not considered when unbundled.

One last thing, make sure that when you look up codes to see if they are billable together, that you look them both up in Column 1 codes. What I mean by this is that if you want to see if 99213 and 99214 are billable together (I know that they're not but just follow me on this...), you first look up code 99213 as a Column 1 code and see if 99214 is considered a component of it. Then, look up code 99214 as a Column 1 code and see if 99213 is considered a component of it. You get what I mean?

Anyway....I hope that helps. Below is the link for the online CCI Edits on CMS. I used to do a lot of coding and auditing when I worked for a large billing company for different types of surgeons and specialties and worked a great deal with the CCI Handbook. It can also come in handy when working on overturning denials.

http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp
 

Rncoder

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WOW!! Great answers...i will have to digest it all and look them up to see what you are telling me but what great direction!! I have a cci edit book but thanks for the link. I have only been codin a short time...and i am just now realizing that the more i know...the more i know I don't know!! :D thanks everyone.
 

Rncoder

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ok...one more question. When it comes to facility billing....not physician...do ssi edits still apply. for example...an ng tube is a cci edit for critical care e/m level.....i always think of facility billing as charging for what the nurses do...so ...do cci edits apply to both physician ANd FACILITY CHARGES?? thanks
 

Rncoder

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I think i found the answer to that . cci edits are mainly used for physician services and the OCE from the OPPS are what i need to use..for facilty billing. thanks..it also said that cci edits do not pertain to critical care or e/m hopsital codes....so much to learn.... thanks
 
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Hey there,

I forgot to tell you....since you mentioned that you have the printed CCI Edits...I included the cms link for you because there are changes to the printed texts every 4 months. I thought that if you had access to them on-line you could stay most up to date. :)
 
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OOps....every 3 months! So there are 4 updates that are usually included in a 1-year subscription. Sorry about they typo!
 

RebeccaWoodward*

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Kristi,

Do you have this link handy?

http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage

Addendum...I just realized Sylvia posted this link, also. Depending what specialty you're in, you can order books from Ingenix that provide this information. We have the Neurosurgery and Orthopedic manuals. They are helpful but I prefer going to the link for this information.
 
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Suzieqtk

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unbundle

Sylvia,

I hope you are still a member. I love your explaination! Too many people give short answers and don't explain to the others that have little or no experience. One question to clarify what you are saying. I was asked if 0195T was unbundled what are all the codes that are intregal to it. I went to CCI edits and column 2 with all the other codes were MANY, are all those codes consider intregal (or bundled into) 0195T? Theres like 15 or 20 that's why I'm asking. I thought it was just , discectomy, decompression, instrumentation and imaging :). I hope you are still around to answer but if anyone knows please feel free.

Thank you,

Susan





Hi,

CCI means "Correct Coding Initiative" and they are contained in the CCI Edits Handbook. You can find it online via an excel format on the CMS website or you can subscribe to the written texts that are for sale.

Basically there are 2 colums which contain cpt codes. Column 1 is your main code/procedure and when you want to bill another service with it, you can look up to see if doing so would "unbundle" the 2 services. Column 2 shows all the codes that are considered "components" of the main code found in Column 1.

For example, look up code 99213 in Column 1. Next to it will be a large number of cpt codes - all the codes that are considered "bundled" into the 99213. There is a third colum which show "indicators" - (0) means that there is no way that any payor would allow payment or billing of the combination of codes found in that row, there is no modifier you can add, there is no documentation you can send, etc. Basically, the two codes are not billable together. An indicator of (1) means that a modifier can be appended to the cpt code in Column 2 to allow it to be unbundled and therefore considered separately for payment. Remember that the modifier goes on the cpt code in Column 2. Typically, this modifier is (-59).

Lastly, there is a grouping called "Mutually Exclusive" codes. These are cpt codes that are inherently considered components of each other and therefore not considered when unbundled.

One last thing, make sure that when you look up codes to see if they are billable together, that you look them both up in Column 1 codes. What I mean by this is that if you want to see if 99213 and 99214 are billable together (I know that they're not but just follow me on this...), you first look up code 99213 as a Column 1 code and see if 99214 is considered a component of it. Then, look up code 99214 as a Column 1 code and see if 99213 is considered a component of it. You get what I mean?

Anyway....I hope that helps. Below is the link for the online CCI Edits on CMS. I used to do a lot of coding and auditing when I worked for a large billing company for different types of surgeons and specialties and worked a great deal with the CCI Handbook. It can also come in handy when working on overturning denials.

http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp
 
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cpc

Hi Sylvia, I was reading your answer on the CCI edits and I noticed you are a Billing Supervisor in San Diego. I live in San Diego and worked with Kaiser for 16 years until Nov 15, 2013. There were 15 (coders/billers) that received a lay-off notice. I was wondering if there are any positions where you work. This is my e-mail address: theqtx@yahoo.com Thank you so much. Suzie Chadwick
 
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