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
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Help Guide for NextGen® Enterprise PM 8
Set Up CCI Edits
In File Maintenance, select Libraries > Claim Edits > Claim Edits Libraries. Select the applicable claim edit library. The Claim Edit Library Maintenance window appears. Check the appropriate CCI bundling edits as needed. You can set the CCI bundling edits with a severity level based on business practices. Select System > Payers, and then select the applicable payer. The Modify Payer Information window appears. Select the Practice tab, and then the Libraries tab on the bottom of the window. Attach the claim edit library to the payer by selecting a library in the Claim Edit Library field. Select OK. Bundling CCI Edits CCI Bundling Anesthesia Edits CCI Bundling Lab Edits 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
Mutually Exclusive CCI Edits
Mutually Exclusive codes are those codes that cannot reasonably be done in the same session.CPT codes that are mutually exclusive of one another based either on the CPT definition or the medical impossibility/improbability that the procedures could be performed at the same session can be identified as code pairs. These codes are not necessarily linked to one another with one code narrative describing a more comprehensive procedure compared to the component code, but can be identified as code pairs that should not be reported together. Parent topic: CCI Edits
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 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
Claim Edits Library
Claim edits are a set of conditions that must be (or are suggested to be) met when you generate a claim. For example, is the patient's zip code required in the claim? Must the referring physician's first name appear on the claim? These are the kinds of requirements you can set up to control the information that appears in the claims you generate. The Claim Edits Libraries enable you to select the claim edits to run when billing encounters and generating claims. A default Claim Edits Library must be created and attached at the Practice Preferences level before you can bill encounters and generate claims. After, a default library is created and attached at the Practice Preferences level, you can then create payer-specific Claim Edits Libraries and attach them at the Payer Master level. These payer-specific claim edits libraries override the default Claim Edits Library. The application maintains a list of available claim edits in the Claim Edits Library, which you can access within File M
