Please note that this article contains information that is only relevant to our American clients.
At last, 2017 has arrived and with it comes a number of changes to the Correct Coding Initiative (CCI). The Centers for Medicare and Medicaid (CMS) are no strangers to changes, and this year they’ve made a lot of them.
The CCI edits are relevant to the Medicare program, state Medicaid programs, certain private insurance carriers, and workers’ compensation insurance carriers. As a healthcare provider, it is your responsibility to familiarize yourself with the new CCI edits. Those who choose not to adhere to the new edits may not receive payment for treatments or services rendered, because they’ve included the old CPT codes in their claims submissions.
The CCI was established with the hopes of promoting the correct coding methodologies across the country. In effect, they reduce instances of “improper coding leading to inappropriate payment in [Medicare] Part B claims,” as stated by Rick Gawenda of Gawenda Seminars and Consulting. These edits seek to guarantee that the most comprehensive groups of codes are billed, and that the most appropriate codes are grouped together.
The folks from Gawenda Seminars and Consulting have been kind enough to prepare several documents containing detailed information about the CCI edits. To access them, see the links below:
CCI Edits – Private Practice(Version 23.0 Effective January 1, 2017)
CCI Edits – Nonprivate Practice(Version 23.0 Effective January 1, 2017)
CCI Edits – Private Practice(Excel spreadsheet) Version 22.3 effective October 1, 2016
CCI Edits – Nonprivate Practice(Excel spreadsheet) Version 22.3 effective October 1, 2016