The CCI edits are part of the Outpatient Code Editor (OCE) that edits all outpatient claims and assigns APCs for Outpatient PPS services. In the past, the Outpatient Code Editor (OCE) did not include CCI edits for the following: anesthesiology, evaluation, and management, and mental health services.
Effective for dates of service on or after 01/01/09, the CCI edits will not categorically exclude any types of services. Bypass modifiers and coding pairs in the OCE may differ from those in the NCCI because of differences between facility and professional services. The OCE generates CCI edits when OPPS claims are processed for payment.
The edits address two major types of coding situations:
- Column 1/Column 2 Correct Coding Edits (formerly Comprehensive/Component) apply to code combinations where one of the codes maybe a component of a more comprehensive code. Although the column 2 code is often a component of a more comprehensive column 1 code, this relationship is not true for many edits in this table. The code pair edit may simply represent two codes that should not be reported together. For example, a provider should not report a laparoscopic cholecystectomy code and an open cholecystectomy code together. The edit allows payment for the column 1 code only.
- Mutually exclusive code edits include those codes that cannot reasonably be done in the same session. An example of a mutually exclusive situation is when the repair of the organ can be performed by two different methods. One repair method must be chosen to repair the organ and must be reported. A second example is the reporting of an “initial” service and a “subsequent” service. It is contradictory for a service to be classified as an initial and a subsequent service at the same time. CPT codes that are mutually exclusive of one another based either on the CPT definition or the medical impossibility/improbability that the procedures could be performed at the same session can be identified as code pairs. These codes are not necessarily linked to one another with one code narrative describing a more comprehensive procedure compared to the component code, but can be identified as code pairs that should not be reported together.
This web page will not address specific CCI edits. If you have concerns regarding specific CCI edits, please submit your comments in writing to:
National Correct Coding Initiative
Correct Coding Solutions LLC
P.O. Box 907
Carmel, IN 46082-0907
Attention: Niles R. Rosen, M.D., Medical Director and Linda S. Dietz, RHIA, CCS, CCS-P, Coding Specialist
Fax #: 317-571-1745
Both the Outpatient Code Editor with Ambulatory Payment Classification and the CCI Edits Manual products may be purchased from the National Technical Information Service (NTIS) website located in the Related Links Outside CMS section below at, or by contacting NTIS at 1-800-363-2068 begin_of_the_skype_highlighting 1-800-363-2068 end_of_the_skype_highlighting or 703-605-6060 begin_of_the_skype_highlighting 703-605-6060 end_of_the_skype_highlighting.