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.

CCI edits are pairs of CPT or Healthcare Common Procedure Coding System (HCPCS) Level II codes that are not payable separately, except under certain circumstances. The edits are applied to services billed by the same provider for the same beneficiary on the same date of service. All claims are processed against the CCI tables. If each procedure/service is performed by different physicians, both procedure/service codes are payable.

Mutually exclusive codes represent procedures that could not reasonably be performed at the same session by the same provider on the same patient.

For detailed information about CCI Edits, go to the CMS website.