Content Section
|
Medicare Information Resource
|
Note: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material which is copyrighted by the American Medical Association (AMA). You are forbidden to download the files unless you read, agree to and abide by the provisions of the copyright statement. Read the copyright statement now (you will be linked back to here).
|
MIR-20007-1AB, January 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
|
Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 13.0, Effective January 1, 2007
Provider Types Affected
Physicians who submit claims to Medicare carriers and A/B Medicare Administrative Contractors (A/B MACs)
Background
This article and related Change Request (CR) 5422 provide a reminder for physicians to take note of the quarterly updates to the coding initiatives. The latest package of Correct Coding Initiative (CCI) edits, Version 13.0, effective January 1, 2007, will be available via the CMS Data Center (CDC).
Physicians may view the current CCI edits and the current Mutually Exclusive Code (MEC) edits at http://www.cms.hhs.gov/NationalCorrectCodInitEd/  on the Centers for Medicare & Medicaid Services (CMS) Web site.
The National Correct Coding Initiative developed by CMS helps promote national correct coding methodologies and controls improper coding. The coding policies developed are based on coding conventions defined in the American Medical Association’s Current Procedural Terminology (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 latest package of CCI edits, Version 13.0, is effective on January 1, 2007. This version will include all previous versions and updates from January 1, 1996 to the present and will be organized in two tables:
- Column 1/Column 2 Correct Coding Edits table; and
- MEC Edits table.
Additional Information
The CCI and MEC file formats will be maintained in the Medicare Claims Processing Manual (Publication 100-04), Chapter 23, Section 20.9, which can be found at http://www.cms.hhs.gov/Manuals/IOM/list.asp#TopOfPage on the CMS Web site.
You may see the official instruction (CR5422) issued to your Medicare carrier or A/B MAC by going to http://www.cms.hhs.gov/Transmittals/downloads/R1124CP.pdf  on the CMS Web site.
If you have questions, please contact your Medicare carrier or A/B MAC, at their toll-free number which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Flu Shot Reminder
As a respected source of health care information, patients trust their doctors’ recommendations. If you have Medicare patients who haven’t yet received their flu shot, help protect them by recommending an annual influenza and a one time pneumococcal vaccination. Medicare provides coverage for flu and pneumococcal vaccines and their administration. – And don’t forget to immunize yourself and your staff. Protect yourself, your patients, and your family and friends. Get Your Flu Shot. Remember - Influenza vaccination is a covered Part B benefit. Note that influenza vaccine is NOT a Part D covered drug. For more information about Medicare’s coverage of adult immunizations and educational resources, go to CMS’s Web site: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf .
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5422
Pub. 100-4, Transmittal# R1124CP, CR# 5422
Related CR Release Date: December 8, 2006
Effective Date: January 1, 2007
Implementation Date: January 2, 2007
Do you have your NPI? National Provider Identifiers (NPIs) will be required on claims sent on or after May 23, 2007. Every health care provider needs to get an NPI. Learn more about the NPI and how to apply for an NPI by visiting http://www.cms.hhs.gov/NationalProvIdentStand/ on the CMS Web site.
|
