What are CCI edits and how do I know which CPT codes cannot be used with other CPT codes?
The Correct Coding Initiative was developed by the CMS to promote national correct coding methodologies to control improper coding that leads to inappropriate payment for Medicare Part B carriers. The coding policies developed are based on the AMA’s CPT codes, coding guidelines developed by national societies through analysis of standard medical coding practice. The CCI identifies edits that are “Mutually Exclusive Procedures”. These are codes that cannot be performed on the same date of service. Other edits are “Comprehensive and Component Procedures” or code combinations that will not be reimbursed on the same date of service unless a modifier is used. The AOTA states that these “edits raise a red flag for carriers when determining reimbursement”. Therapist should use the –59(distinct procedural services) modifier on one of the edited pair. The note should provide an explanation of why both procedures were medically necessary with either different goals or treatment to a different bo
