Cardiology Coding Alert

Hint: Always become familiar with CCI edits for any new procedures.

Make sure your practice doesn't fall behind and your reimbursement doesn't suffer as you learn the new CCI 24.0 edits. Check out these indispensable tips from our experts and put your practice on the road to coding success today.

Tip 1: Always Double-check the CCI Edits Before Submitting a Claim

Procedure-to-procedure (PTP) edits are reviewed and revised on a quarterly basis, and this data is usually available several weeks before the start of a new quarter, according to Ruby Woodward, BSN, CPC, CPMA, CPB, COSC, CSFAC, CPC-I, coding and compliance manager at Suburban Imaging/Suburban Radiologic Consultants in Minneapolis, Minnesota.

"It is imperative for anyone assigning codes to claims for multiple services provided on the same day under the same tax ID and specialty to check those edits prior to claim submission," Woodward adds. "I strongly recommend not relying on memory and always checking the edits when submitting claims for multiple services on the same DOS."

Learn more: Visit www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html and see the menu on the left side of the Web page to find the PTP edit tables.

Tip 2: Remember Documentation is Key to Supporting Override

"If documentation supports reporting both procedures (with modifier), and one procedure is denied, always appeal," says Dolly Perrine, CCS-P, CPC, CPC-I, CUC, CPMA, auditor and educator of professional services at St. Charles Health System in Bend, Oregon. "I have found that if I have supporting documentation and the claim is denied due to bundling, if I appeal, it would most always be paid. I'm aware that it takes additional time to appeal, but once again, that's money left on the table."

Tip 3: Utilize Helpful Supplemental Resources

Ongoing education through newsletters, periodicals, and reference books is also important for CCI edit success, says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, staff services coordinator/billing/credentialing/auditing/coding at County of Stanislaus Health Services Agency in Modesto, California.

"In addition, investing in good software or programs that will let you easily cross-check codes against each other is a huge time-saver," Johnson adds. "Becoming an expert in CCI edits will save your office a ton of time and help with quicker reimbursements."

Editor's note: Stay tuned to Cardiology Coding Alert for CCI info throughout the year. Codify also offers a tool, CCI Edits Checker, which makes checking your claim for CCI edit conflicts as efficient as possible - letting you see everything you need to know at a glance. This coder-designed tool makes it easy to download a PDF of your results and checks CCI edits for up to 25 codes at a time. Try a 14-day free trial here: https://www.aapc.com/codify/cci-edits.aspx.

Tip 4: Know Your Individual Payers' Policies

Remember that the CCI edits were created for Medicare and most government payers, Woodward says. So, it is important to know how your commercial payers utilize these edits - if at all.

"Do they follow the full edit, meaning the guidelines and the tables, or just the tables? Do they also follow the specialty societies global policies if they exist?" Woodward says. "If CCI says the services are bundled with an indicator of 1, but the specialty society says the procedure is not inclusive, will the health plan honor the specialty society and the use of the 59 or other appropriate modifier?"

Tip 5: Become Familiar with CCI Edits for Any New Procedures

"Don't be intimidated," says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, manager of clinical compliance with PeaceHealth in Vancouver, Washington. "There are thousands of edits, but many of them are common sense, and many others will not apply to you because the services involved are not performed by providers you work with."

When you start coding a new procedure or service, take a look at the edits and also look for any [local coverage determinations] LCDs or [national coverage determinations] NCDs, and that will probably be enough to help you manage CCI edits well, Bucknam adds.