tci Medicare Compliance & Reimbursement - 2018 Issue 17

Reader Question: Master CCI Edits with Unlikely, Exclusive Expertise

Question: The Correct Coding Initiative (CCI) is an enigma to me; I have a lot of trouble with the terminology. For instance, what is the difference between mutually exclusive edits, and medically unlikely edits? Michigan Subscriber Answer: Though they may sound similar on the surface, CCI identifies them as completely different kinds of edits. CMS defines CCI Procedure-to-Procedure (PTP) code pair edits — Column 1 and Column 2 edits — as “automated prepayment edits that prevent improper payment when certain codes are submitted together.” In other words, the Column 2 code is a procedure that is a...

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