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.