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Correct Coding Initiative (CCI) Edits

What are Correct Coding Initiative (CCI) Edits?
CCI Edits are a Centers for Medicaid and Medicare Services (CMS) billing provision to prevent the unbundling of services. CMS publishes a quarterly list of edits that include comprehensive/component and mutually exclusive code pairs that cannot be billed together on the same date of service.

Comprehensive/Component Code Pairs in Outpatient Rehabilitation
Comprehensive/component code pairs are those codes where a limited procedure (component) cannot be billed in conjunction with a more extensive procedure (comprehensive) that traditionally includes the limited procedure as well. For example, gait Training, CPT 97116, is a component of Orthotic Fitting and Training, CPT 97540.

Mutually Exclusive Code Pairs in Outpatient Rehabilitation
Mutually exclusive code pairs are those pairs of services that cannot be logically performed together on the same date of service, and therefore cannot be billed on the same date. For example, Physical Therapy Evaluation 97001 and Physical Therapy Re-evaluation (97002) cannot be billed together on the same date of service.

When is it acceptable to bill code pairs together?
CMS publishes a table quarterly that lists when instances of billing these code pairs together is acceptable ( In the table, code pairs are labeled either "0" or "1". If the pair is labeled "0," there are no circumstances where billing the combination of codes would be appropriate. If the code pair is labeled "1," a Current Procedural Terminology (CPT) modifier (-59) can be attached to the component code to provide a brief explanation as to why the two procedures occurred on the same day.

To learn more about how Chart Links can help your facility with CCI Edits, contact us.