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The CCI edits are part of the Outpatient Code Editor (OCE) that edits all outpatient claims and assigns APCs for Outpatient PPS services. In the past, the Outpatient Code Editor (OCE) did not include CCI edits for the following: anesthesiology, evaluation; management, and mental health services. Effective for dates of service on or after 01/01/09, the CCI edits will not categorically exclude any types services. Bypass modifiers and coding pairs in the OCE may differ from those in the NCCI because of differences between facility and professional services. The OCE generates CCI edits when OPPS claims are processed for payment. The edits address two major types of coding situations: - Column 1/Column 2 Correct Coding Edits (formerly Comprehensive/Component) apply to code combinations where one of the codes is a component of a more comprehensive code. The edit allows payment for the comprehensive code only.
- Mutually exclusive codes are those codes that cannot reasonably be done in the same session. An example of a mutually exclusive situation is when the repair of the organ can be performed by two different methods. One repair method must be chosen to repair the organ and must be reported. A second example is the reporting of an "initial" service and a "subsequent" service. It is contradictory for a service to be classified as an initial and a subsequent service at the same time. CPT codes that are mutually exclusive of one another based either on the CPT definition or the medical impossibility/improbability that the procedures could be performed at the same session can be identified as code pairs. These codes are not necessarily linked to one another with one code narrative describing a more comprehensive procedure compared to the component code, but can be identified as code pairs that should not be reported together.
This web page will not address specific CCI edits. If you have concerns regarding specific CCI edits, please submit your comments 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 Both the Outpatient Code Editor with Ambulatory Payment Classification and the CCI Edits Manual products may be purchased from the National Technical Information Service (NTIS) website located in the Related Links Outside CMS section below at, or by contacting NTIS at 1-800-363-2068 or 703-605-6060.
Page Last Modified: 09/17/2008 2:09:50 PM
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