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) 5824, which provides a reminder for physicians to take note of the quarterly updates to Correct Coding Initiative (CCI) edits. The National Correct Coding Initiative developed by the Centers for Medicare & Medicaid (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.

Key Points
The latest package of CCI edits, Version 14.0, will be effective January 1, 2008. Version 14.0 of the CCI edits will include all previous versions and updates from January 1, 1996 to the present and will be organized into two tables:

• Column 1/Column 2 Correct Coding Edits; and
• Mutually Exclusive Code (MEC) Edits

Additional information about CCI, including the current CCI and MEC edits, is available at http://www.cms.hhs.gov/NationalCorrectCodInitEd on the CMS Web site.

Additional Information
The CCI and MED file formats are defined in the Medicare Claims Processing Manual, Publication 100-4, Chapter 23, Section 20.9, which can be found at http://www.cms.hhs.gov/manuals/downloads/clm104c23.pdf on the CMS Web site.

The official instruction, CR5824, issued to carriers and A/B MACs regarding this update may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1386CP.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 at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

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.

News Flash - It's seasonal flu time again! If you have Medicare patients who haven’t yet received their flu shot, you can help them reduce their risk of contracting the seasonal flu and potential complications 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 – Not the Flu! Remember - Influenza vaccination is a covered Part B benefit but the influenza vaccine is NOT a Part D covered drug. Health care professionals and their staff can learn more about Medicare’s coverage of adult immunizations and related provider education resources, by reviewing Special Edition MLN Matters article SE0748 http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf on the CMS Web site.

News Flash - Effective March 1, 2008, Medicare fee-for-service 837P and CMS-1500 claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. You may not submit claims containing only a legacy identifier in the primary fields. Failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable beginning March 1, 2008. Until further notice, you may continue to include legacy identifiers only for the secondary fields.

Posted: 12/07/2007