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MIR-2007 07B, July 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 13.2, Effective July 1, 2007
Provider Types Affected
Physicians who submit claims to Medicare carriers and A/B Medicare Administrative Contractors (A/B MAC)
Background
This article is based on Change Request (CR) 5604 which provides a reminder for physicians to take note of the quarterly updates to Correct Coding Initiative (CCI) edits. The latest package of CCI edits, Version 13.2, effective July 1, 2007, and the current Mutually Exclusive Code (MEC) edits will be available 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 (AMA’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 13.2, includes 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, and
- Mutually Exclusive Code (MEC) Edits.
Additional Information
The CCI and MEC file formats will be maintained in the Medicare Claims Processing Manual (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.
The official instruction, CR 5604, issued to your carrier and A/B MAC regarding this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1243CP.pdf  on the CMS Web site.
If you have any questions, please contact your Medicare carrier or A/B MAC at their toll-free number, which may be found on the CMS Web site at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  .
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: MM5604
Pub. 100-4, Transmittal# R1243CP, CR# 5604
Related CR Release Date: May 18, 2007
Effective Date: July 1, 2007
Implementation Date: July 2, 2007
Medicare Fee-For-Service (FFS) Contingency Plan Announced!
Effective May 23, 2007, Medicare FFS is establishing a contingency plan for implementing the National Provider Identifier (NPI). In this plan, as soon as Medicare considers the number of claims submitted with an NPI for primary providers (Billing, pay-to and rendering providers) is sufficient, Medicare (after advance notification to providers) will begin rejecting claims without an NPI for primary providers, perhaps as early as July 1, 2007. For more information on this contingency plan, please visit the NPI dedicated Web site at http://www.cms.hhs.gov/NationalProvIdentStand/ .
| CPT five-digit codes, descriptions, and other data only are copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS clauses apply. |
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