FAQs to help your understanding of CCI edits

The quarterly Correct Coding Initiative edits (CCI 17.2) have gone into effect on July 1 this year. This time it offers 2,367 new edit pairs and deletes 336 bundles. So whether you're new to coding or have been dealing with them for years this is just the right time to take up a refresher on these edits. These frequently asked questions (FAQ) will help your understanding of these edits.

a) Is it ok to override CCI edits?

In some clinical circumstances you can override - but not ignore - these edits and get reimbursement for bundled codes. So if you want to know whether you can bill services separately, first take a look at the modifier indicator in column F of the CCI spreadsheet.

While a "0" indicator will mean that you can't unbundle the two codes under any circumstances, an indicator of "1" will mean that you may use a modifier to override the edit if the clinical circumstances demand separate payment.

Remember: The most frequently used modifiers that Part B practices use to override an edit pair are 25 when used with an associated E/M code or 59 when two non- E/M services are carried out; however other modifiers may apply in some circumstances.

CCI edits apply to Part B practices only - is it?

Even though all Part B payers follow the CCI Edits, many other payers take them into consideration while determining which procedures should be paid separately.

You shouldn't bill patients when exceeding medically unlikely edits (MUE) limits - is this true?

If you think that patients can be balance billed for this, you are not alone. However there are many others like you who believe this common MUE myth. The truth is that even if you have the patient sign an advance beneficiary notice (ABN), you can't pass on the cost of procedures you know will be denied owing to MUEs.

Remember: You should keep edits in mind for other payers apart from Part B MACs.

Things you should know before you start your self-audit process

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Regular internal audits are a must for your practice if you don't want the auditor to catch you unawares when it comes knocking on your door. When you conduct regular internal audits, you'll not lose money and overlook billing mistakes that could lead to missed medical billing opportunities.

But before starting your self-audit process, you should practice these key things:

Make everyone in your practice understand why an audit is important

You should make everyone in your practice realize why an internal audit will benefit your practice. These audits are a way to ensure you're on track. By conducting internal audits you can identify opportunities for education, for the development of better forms and to tune up the practice.

In addition, internal chart audits make it possible to find and rectify medical coding errors and self report, rather than letting the payer find them. If your staff members are hesitant to participate, let them know that the point of the audit is not to search for mistakes and land people in trouble; but it's to improve coding down the line.

Choose between the two types of internal chart audits

The two types of internal chart audits are prospective audit (where your practice examines new claims before you file them) and retrospective audit (your practice examines paid claims). Your practice must determine for itself what types of audits your staff can reasonably complete and what effects on claim submission timing and cash flow the practice can handle.

Know how often your practice should perform an internal audit

One more question that you need to ask is how often your practice performs an internal audit. Here, the size and type of your practice determines how often your practice performs an internal audit. Take into consideration the amount of resources the practice can devote to the audit while conducting day-to-day office business simultaneously. The more audits your practice carries out, the cleaner your claims will be. On an average, you should conduct at least two internal audits a year. After you perform an audit, you need to define the focus of the audit.

Also determine the audit's scope

Lastly, you should also know which providers, services, date range and payers it'll address.