News Brief:
Look for Corrections to CCI Version 6.1 Errors
Published on Sat Apr 01, 2000
Due to a large number of errors, the implementation of the national Correct Coding Initiative (CCI) version 6.1 has been delayed from April 1 to May 1, 2000. Users of any CCI edit products should make certain that they have a corrected copy of version 6.1 before its implementation on May 1, either in the form of an errata sheet or, in some cases, an updated book, says Laurie Castillo, MA, CPC, president of Physician Coding and Compliance Consulting, a physician consulting firm in Manassas, Va.
The National Technical Information Service (NTIS) publishes the CCI edits, along with several other commercial resellers who purchase the raw data from NTIS. According to NTIS, all of their customers, including subscribers and resellers, received an errata sheet soon after the Health Care Financing Administration (HCFA) made the NTIS aware of the errors.
We received 37 pages of changes from NTIS, confirms Tony Mistretta, editor at Medical Management Institute, one of the licensed resellers of the CCI edits. We are not redoing our manuals or electronic products, but we are sending errata to our subscribers, he says.
Those who purchased CCI edits from another source also should look for corrections to version 6.1 in time for the May 1 implementation. For NTIS customers, this has been sent out in the form of an appendix, which must be cross-referenced to the version 6.1 product. Other resellers should have received the errata sheet from NTIS and made arrangements to get that information to their customers.
How CCI Works
In response to direction from Congress, CCI edits were initiated in 1996 to reduce Medicare program expenditures by detecting inappropriate coding on claims. The CCI edits are basically a list of code pairs that Medicare will not reimburse together for the same patient on the same day because they represent services that are bundled or would not ordinarily be performed together, explains Castillo. Reporting two of these codes together for the same service represents fraudulent unbundling, which is the practice of breaking down a single procedure into its component parts, and billing for additional services.
There are times, however, when two of these codes might legitimately be coded together, if they represent two services that are distinct and independent from each other, says Castillo. To indicate that the codes represent separate services as opposed to unbundling of a single service, coders should use appropriate modifiers, such as CPT modifier -59 (distinct procedural service).
Correct Coding Modifier 0 and 1
The CCI edits list code pairs that are excluded based on two relationships:
1. one code is comprehensive and includes the service of the other component code; or
2. the two codes are mutually exclusive, such [...]
