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Thread: what do CCI edits mean??

  1. #11
    Join Date
    Apr 2007
    North Carolina


    AAPC: Back to School

    Do you have this link handy?


    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.
    Last edited by RebeccaWoodward*; 11-06-2008 at 03:11 PM.

  2. #12

    Default unbundle


    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,


    Quote Originally Posted by thompsonsyl View Post

    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.


  3. #13

    Default 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

  4. #14
    Join Date
    Apr 2007
    Austin, Texas



    How to Use the Medicare National Correct Coding Initiative (NCCI) Tools

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