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2017 CCI Updates to Ensure Revenue Integrity!

Ensure a complete understanding of the latest CCI Edits effective January 1, 2017! Learn about the latest changes that may affect billing and coding and how to ensure revenue integrity within your practice.

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2017 CCI Updates to Ensure Revenue Integrity!

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  1. 2017 CCI Edits to Ensure 2017 CCI Edits to Ensure Revenue Integrity! Revenue Integrity! Presented By: Presented By: Rachel M. Kaser, BS, CPC, MHSA Rachel M. Kaser, BS, CPC, MHSA AHIMA AHIMA- -Approved ICD Approved ICD- -10 Auditor; SuperCoder.com 10- -CM/PCS CM/PCS Trainer Trainer

  2. Course Objectives Course Objectives • Definition of CCI Edits and their importance • Detailed explanation of 2017 edits • Understanding modifiers for CCI edits • Review of CCI policy manual changes effective January 1, 2017 2

  3. CCI and NCCI Edits: Basic Overview CCI and NCCI Edits: Basic Overview • National Correct Coding Initiative (NCCI) • Correct Coding Initiative (CCI) • Created by CMS to “promote national correct coding methodologies and to control improper coding leading to inappropriate payments on Part B claims.” • www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html 3

  4. National Correct Coding Initiative (CCI) National Correct Coding Initiative (CCI) • Implemented by CMS • Promotes correct coding methodologies • Controls the improper assignment of codes that results in inappropriate reimbursement Medicare Publishes CCI: http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html 4

  5. National Correct Coding Initiative National Correct Coding Initiative (NCCI (NCCI) ) • Additions/revisions to the manual have been italicized in red font • NCCI Procedure-to-Procedure(PTP); January 1, 1996 and began implementing Medically Unlikely (MUE) edits on January 1, 2007 • A corresponding set of PTP edits is incorporated into the outpatient code editor (OCE) for OPPS and therapy providers 5

  6. 2017 2017 Edition Edition of Correct Coding Initiative (CCI) of Correct Coding Initiative (CCI) Edits Edits, Version 23.0 , Version 23.0 • Version 23.0: Effective for claims filed on or after January 1, 2017 • Organized in Two Tables: • Column 1 / Column 2 Correct Coding Edits • Mutually Exclusive Code (MEC) Edits 6

  7. 2017 2017 Edition Edition of Correct Coding Initiative (CCI) of Correct Coding Initiative (CCI) Edits Edits, Version 23.0 , Version 23.0 • Updated Quarterly: • 1st Quarter: 2nd Quarter: 3rd Quarter: 4th Quarter: • Deleted effective January 1, 2017 • Take a look at those to ensure your practice is aware of the changes to ensure efficient and clean submission of claims January 1st - March 31st April 1st - June 30th July 1st - September 30th October 1st - December 31st 7

  8. 2017 2017 Edition Edition of Correct Coding Initiative (CCI) of Correct Coding Initiative (CCI) Edits Edits, Version 23.0 , Version 23.0 • The spreadsheet shows 99,490 CCI edit additions for January 1, 2017! • Additions emphasize Spinal Injections and Moderate Sedation • Additions of bundling for the integumentary system codes into new surgical procedure codes • Bundling of radiology codes into new codes that specifically include imaging guidance 8

  9. 2017 2017 Edition Edition of Correct Coding Initiative (CCI) of Correct Coding Initiative (CCI) Edits Edits, Version 23.0 , Version 23.0 • Deletions: 55,760 • The deletions remove edits for 62310-62319 (which 62320-62327 replace) and 99143-99150 (which 99151-99157 replace) 9

  10. 2017 2017 Edition Edition of Correct Coding Initiative (CCI) of Correct Coding Initiative (CCI) Edits Edits, Version 23.0 , Version 23.0 Always Check the Modifier Indicator Changes: • The tab showing modifier indicator changes is an important one because it shows existing edits that have new reporting rules • You’ll see which edits have been changed from modifier indicator 0 to modifier indicator 1 and vice versa • Ensure you check the individual edits before making any final coding decisions 10

  11. 2017 2017 Edition Edition of Correct Coding Initiative (CCI) of Correct Coding Initiative (CCI) Edits Edits, Version 23.0 , Version 23.0 • Change from 0 to 1 (may override): • Edits bundling paravertebral block codes 64461 and 64463 into trigger point injection codes 20552 and 20553 • Edits bundling A95xx radiopharmaceutical codes into certain 783xx and 788xx nuclear medicine codes • Edits bundling 95941 and G0453 (intraoperative neurophysiology monitoring from outside the OR) into 95940 (intraoperative neurophysiology monitoring from inside the OR) 11

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