Gastroenterology Coding Alert

Question: A coder in my practice is asking me a lot of questions about CCI Edits 16.3. What should we expect with the version 16.3, which recently came out?

Alaska Subscriber

Answer: First, the basics. The National Correct Coding Initiative (CCI) edits contain a list of CPT or HCPCS Level II codes that are not separately payable, except under certain circumstances, when performed with certain procedures. The edits found in version 16.3 takes effect on Oct. 1, and will continue to be the rule until Dec. 31. This latest package contains a total of 19,667 additions (33 mutually exclusive edits; 19,634 non-mutually exclusive edits), and 31 deletions.

As one who bills the claim, make sure you check the CCI edits when a physician provides more than one services for the same patient on the same date of service.

Review: Two types of CCI edits exist. The first type -- mutually exclusive edits -- describes situations in which it would be medically improbable to perform both billed procedures in the same session. The second type -- bundled or non-mutually exclusive edits (NMEs) -- pair codes consisting of one comprehensive code and one component code. CCI considers the service represented in the component code included in the comprehensive code, and therefore the component code is not separately billable.

Unbundling policy: You can unbundle edits with a status indicator of "1" by using modifier 59 (Distinct procedural service), but correct documentation should support your claim. Find more information about CCI, including the current CCI edits, at www.cms.gov/nationalcorrectcodinited.