Pulmonology Coding Alert

Question: After reading your article last month about which Correct Coding Initiative (CCI) edits allow bronchoscopies to be billed with thoracotomies, I have a follow-up question. When we’re billing a payer other than Medicare Part B, do we have to follow CCI edits, or are they Medicare-specific? 

Answer: Although all Medicare Part B payers follow the CCI edits, many other payers take them into account when determining which procedures should be paid separately.

Example: As part of the Affordable Care Act, state Medicaid programs began using CCI edits when processing their claims. This means that you’ve probably seen CCI edits at work with your Medicaid claims. In addition, many private payers and workers’ compensation insurers also use the CCI to justify claims payment and denials.

Best bet: You should check with your payers to determine which use the CCI edits and which do not.