Ob-Gyn Coding Alert

Youve coded and billed for a total hysterectomy and you think youve done it right. But two weeks after submitting the bill you receive a denial. One of the first things to check is the Correct Coding Initiative (CCI) edits. While these edits specifically apply to Medicare patients, many practices also use the CCI when reviewing denials received from their commercial payers, says Barbara J. Cobuzzi, MBA, CPC, president of Cash Flow Solutions based in Lakewood, NJ.

One method of controlling Medicare costs is ensuring accuracy in Medicare claims processing. With this goal in mind, the Health Care Financing Administration (HCFA) introduced the CCI in January of 1996. This is a system of code edits used by HCFA to screen claims. The system looks at pairs of codes billed together and decides if the claim is billed appropriately or if a denial is to be generated. In addition to its implications, when submitting claims for your Medicare patients, you may find that many commercial insurance carriers have also adopted the CCI code edits to enhance their claims processing.

The CCI edits are continuously updated with a new release issued each quarter. Currently, Version 5.1 is in effect until June 30th. Version 5.2 goes into effect on July 1st, and remains through September 30th. It is important to always consult the appropriate version of the CCI edits related to the claim that is being processed or reviewed.

How to Order the CCI Edits

The CCI edits are distributed through the National Technical Information Service. Call 800-553-6847 for ordering information. You can order the edits in a printed manual format or in an electronic format (CD ROM, diskette, or ASCII datafile).

If you have questions about the information found in the CCI or how to interpret and apply the edits to your practice, you should direct your questions to either your states Medicare carrier, or you can write to AdminiStar Federal (the organization which creates the edits) directly at: HCFA Correct Coding Initiative, Administar Federal, P.O. Box 50469, Indianapolis, Indiana 46250-0469. Several private companies also publish editions of the CCI and many of these companies supply the information on a disk with a search function. Although generally more expensive than the government version, the time-saving search features may be worth the price to some practices.