CCI Edits Overview

The National Correct Coding Edits (NCCI) are developed by AdminaStar Federal (one of the Medicare contracted insurance companies). They are built into the systems that Medicare claims are billed through and indicates if a charge that hits an edit is non-covered. While ZHealth does not see other payors installing the edits—since everyone is supposed to be billed the same—they do have an affect on all payors. The “CCI Edits” are updated every quarter, and hospitals are subject to the edits one quarter behind the physicians.

ZHealth Publishing will be aggregating and consolidating over 20 documents per quarter—and organizing the CCI Edits so that the information will be much more readable and useful for all ZHealth Online members (only). In addition, ZHealth will remove deleted edits, clearly indicate why they are an edit (mutually exclusive vs. component of a more comprehensive procedure) and make it easy to see what edits are 0 edits.

Here is a short excerpt of the CCI that are now in effect for physicians and those that will be in effect for hospitals as of July 1, 2005.

Using the CCI Edits

There are two kinds of CCI edits: “Mutually Exclusive” and “Column 1/Column 2.” “Mutually Exclusive” are procedures that, by their definition, would not be done together, such as an open iliac angioplasty and a percutaneous (closed) iliac angioplasty (normally you’d do one or the other, not both).

Column1/Column 2 edits were previously called Comprehensive/Component edits. The Column 1 code includes the Column 2 code, and so the Column 2 code shouldn’t be billed separately. For example, Bilateral Renal angiography with or without a flush aortogram (75724) is a Column 1 procedure with 75625, abdominal aortography as the Column 2 procedure. Since the renal angiogram includes the aortogram, it should not be billed separately.

There is a designation for what is called a 0 (zero) edit. A 0 edit is one that cannot be over-ridden by use of a modifier. Most edits are able to be bypassed by use of modifiers when certain conditions are met. In the iliac angioplasty example, if the both external iliac arteries needed angioplasty, in rare situations there could be access from both groins: one percutaneous and one cut-down (open). The artery angioplastied through the cut-down access could be billed separately with a 59 modifier appended to indicate it was a distinct procedure from the other angioplasty. Procedures that are designated as a 0 edit will never both be paid. For example, catheter placement in the aorta (36200) is a 0 edit with a Left Heart Catheterization (93510). Since you have to go through the aorta to get to the heart, a catheter placement in the aorta can never be billed separately.