Otolaryngology Coding Alert

Every quarter, the Correct Coding Initiative (CCI) puts out a list of code pairs that Medicare (and many private payers) follow when they reimburse physician practices. The CCI edits list pairs of CPT and HCPCS codes that payers will not reimburse when you bill them together. Medicare and other payers apply these edits to services you bill for the same provider, for the same beneficiary, and on the same date of service.

All edits consist of code pairs that are arranged in two columns (Column 1 and Column 2). Codes that are listed in Column 2 are not payable if performed on the same day on the same patient by the same provider as the code listed in Column 1, unless the edits permit the use of a modifier associated with CCI.

"The purpose of the NCCI edits is to prevent improper payment when incorrect code combinations are reported," CMS explains on its Web site. You can find the current listing of CCI edits, as well as the CCI policy manual, on the CMS Web site at http://www.cms.hhs.gov/NationalCorrectCodInitEd.

CMS updates the CCI edits every quarter, and you should always consult the most recent version when coding.