what is Correct Coding Initiative (CCI) and Commercial Edits in Medical billing

Correct Coding Initiative (CCI) 

CMS developed the National Correct Coding Initiative (CCI) to promote national correct coding methodologies and to eliminate improper coding. CCI edits are developed based on coding conven- tions defined in the American Medical Association ’ s Current Procedural Terminology (CPT) Man- ual, current standards of medical and surgical coding practice, input from specialty societies, and analysis of current coding practice.

AdminaStar Federal, a CMS contractor, develops and refines the CCI, coordinates the receipt of comments, the prioritization of issues, the review and research of previous actions, and discussions with CMS about concerns.

The CCI identifies code pairs based on procedure code descriptions or standard medical practice. These code pairs represent the following:

* Comprehensive code – the major procedure or service when reported with another code. The comprehensive code represents greater work, effort, and time as compared to the other code reported.

* Component code – the lesser procedure or service when reported with another code. The component code is part of a major procedure or service and is often represented by a lower work relative value unit under the Medicare fee schedule as compared to the other code reported.

The volume of edits in each version update is too large to be produced by Medicare carrier or fiscal intermediaries (FIs) through a Medicare bulletin. Therefore, CMS has designated the National Technical Information Services (NTIS) as the sole distributor of the CCI edits. Subscriptions and single issues are available in various formats, including CD-ROM.

For purchasing information, contact NTIS at www.ntis.gov/products/families/cci on the Internet, by phone at 1-800-363-2068 (DC area: 703-605-6000), or by writing to the following address: NTIS Subscriptions Department 5285 Port Royal Road Springfield, Virginia 22161

Commercial Edits

On October 1, 1998, CMS required contractors to implement commercial procedure-to-procedure edits, to detect additional inappropriate procedure code combinations including the following:

* Mutually exclusive procedure - two or more procedures not usually performed during the same patient encounter on the same date of service; and

* Incidental procedure - procedure that requires little additional physician work and/or is not clini- cally integral to the performance of the more complex primary procedure being performed at the same time.

These commercial edits are not part of CCI. In addition, because they are proprietary, they are not available to the public through NTIS or in any other format. Physicians may contact the local Medi- care contractor for information about these commercial edits.

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