Mutually Exclusive CCI Edits

Help Guide for NextGen® Enterprise PM 8

Coding Based on Standard of Medical/Surgical Practice

In order for this system to be effective, it is essential that the coding description accurately describe what actually transpired at the patient encounter. Because many physician activities are integral to a procedure, it is impractical and unnecessary to list every event common to all procedures of a similar nature as part of the narrative description for a code. The principle of the policy is to include these services into the column 1 procedure. These principles include: The service represents the standard of care in accomplishing the overall procedure. The service is necessary to successfully accomplish the procedure; failure to perform the service may compromise the success of the procedure. The service does not represent a separately identifiable procedure unrelated to the procedure planned. Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

Select Mutually Exclusive Edits in the Claim Edit Library

Check √ the appropriate CCI Mutually Exclusive edits as needed. You can set the CCI Mutually Exclusive edits with a Severity level based on business practices. Mutually Exclusive Edit Example Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

Activating CCI Edits

If you want to include CCI edits among your activated Claim Edits, then you can select all the CCI edits. Selecting only some of the CCI Edits is not a best practice, this enables improper coding combinations to be applied to generated claims. Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

CCI Edits

The Centers for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (CCI) to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Part B claims. The coding policies developed are based on coding conventions defined in the American Medical Association's CPT Manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practice and review of current coding practice. The National Correct Coding Policy Manual and edits have been developed for application to services billed by a single provider for a single patient on the same date of service. The purpose of the Correct Coding Initiative (CCI) edits is to ensure that uniform payment policies and procedures are followed by all carriers. When services are accurately coded and reported by physicians proper payment can be guaranteed. Note: You must be licensed for CCI edit

Help Guide for NextGen® Enterprise PM 8

Mutually Exclusive Edit Example

Skin preparation – Shave lesion (11301 – 11313) in conjunction with removal of skin tags (11200). The skin preparation would not be separately reported as the service is necessary to successfully accomplish the skin tag removal procedure. An encounter with CPT 11200 and 11305 codes will show on the Claim Production Status report with the following claim edit. Parent topic: Select Mutually Exclusive Edits in the Claim Edit Library

Help Guide for NextGen® Enterprise PM 8

CCI Bundling Anesthesia Edits

Principles of Medicare coding for anesthesia services involving administration of anesthesia are reported by the use of the anesthesia five-digit CPT procedure codes (00100-01860). These codes specify Anesthesia for followed by a general area of surgical intervention. When the following CPT codes are reported with an anesthesia code, it is assumed that these services are being reported as part of the anesthesia service and so will not be paid in addition to the anesthesia code. Because it is recognized that many of these procedures may occur on the same date of surgery but are not performed in the course of and as part of the anesthesia provision for the day, these codes will be separately paid only if the -59 modifier is appended to the code, indicating that the service rendered was independent of the anesthesia service. CPT codes describing services that, when performed as part of the anesthesia service, would be considered included in the anesthesia code include the following partia

Mutually Exclusive CCI Edits

Recommendations

Coding Based on Standard of Medical/Surgical Practice

Select Mutually Exclusive Edits in the Claim Edit Library

Activating CCI Edits

CCI Edits

Mutually Exclusive Edit Example

CCI Bundling Anesthesia Edits

Coding Based on Standard of Medical/Surgical Practice

Select Mutually Exclusive Edits in the Claim Edit Library

Activating CCI Edits

CCI Edits

Mutually Exclusive Edit Example

CCI Bundling Anesthesia Edits