Optum360 coding books logo
Optum360Coding.com
    Contact Us   (7 a.m.–7 p.m. CST)
  Home > Coding Central Articles > Coding Central Articles  
Coding Central
Coding Central Home
Inside Track to ICD-10
Coding Central Articles
Code This!
Case Studies
Chargemaster Corner

Articles for:
March 27, 2018


Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More


Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More


OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More


View Article Archive

Subscribe:
To subscribe, paste this link into your preferred feedreader, or click on one of the buttons below:
 

Medical Coding News Archives

CMS Releases CCI Version 15.2

 
July 14, 2009:

The latest version of the Correct Code Initiative (CCI) has been released by the Centers for Medicare and Medicaid Services (CMS).

This version, which goes into effect on July 1, 2009, has the following number changes from version 15.1:

Code Range

Edits Added

Edits Deleted

Edits Revised

00000

2,358

1,080

0

10000

5

352

0

20000

51

1,502

1

30000

48

862

1

40000

107

721

0

50000

19

693

0

60000

637

769

9

70000

224

8

0

80000

0

0

2

90000

83

94

0

HCPCS Level II
Category III

33

9

1

TOTAL

3,565

6,090

14

There are two basic types of code combinations:

  • Column 1/column 2 Correct Coding Edits (formerly called comprehensive/component code combinations)
  • Mutually exclusive coding combinations

All of the edits, whether they are column 1/column 2 Correct Coding Edits or mutually exclusive edits, are composed of code pairs arranged in two columns. For both sets of edits, the column 2 code is not payable with the column 1 code unless the edit permits use of an appropriate modifier associated with CCI.

CMS authorized an indicator that specifies whether modifier 59 Distinct procedural service, can be used to bypass the CCI edits. This is not, however, a method by which practices can circumvent the CCI edits, and several coding combinations are denied regardless of the use of modifier 59. If a provider files a claim for services included in the CCI edits and the services are identified on the indicator list as payable only for the column 1 service, Medicare will deny the column 2 service as part of the comprehensive service. The use of modifier 59 (or any other modifier) will not avoid the denial of the service. The provider cannot collect payment from the patient or patient’s secondary insurance for the denied component.

Currently the CCI edits are being administered by Correct Coding Solutions, LLC. In addition, it should be noted that many other non-Medicare payers have adopted the CCI as their method to determine unbundling of claims. Your Medicare carrier is unable to change the correct coding edits. Concerns regarding specific correct coding edits should be submitted in writing to:

National Correct Coding Initiative
Correct Coding Solutions LLC
P.O. Box 907
Carmel, IN 46082-0907
Attention: Niles R. Rosen, M.D., Medical Director and
Linda S. Dietz, RHIA, CCS, CCS-P, Coding Specialist
Fax: 317.571.1745

Providers may appeal claim or service denial because modifier 59 was omitted. Providers should simply amend the claim by adding modifier 59 and refile it, along with documentation, with the Medicare contractor. By using the modifier, the provider is certifying that there is appropriate documentation in the patient’s chart.

Deborah C. Hall
Clinical/Technical Editor

 

 
Sign in to
Your Account
USERNAME
Forgot your username?
PASSWORD
Forgot your password?
Don't have an account?
It's easy to create one.

Promo code

Have a promotional source code? Enter it here:


What is this?
Shop our catalog
Request or check out the electronic version of our latest catalog.

Medical Coding Books Winter 2018 Catalog