Medicare CCI Edits Extended to All Providers Medicare billing edits, administered by the National Correct Coding Initiative (NCCI or, more commonly, CCI), restricts certain pairs of evaluation and/or treatment procedures from being billed on the same day for the same patient. With the edits being extended to all provider settings on Jan. 1, the following questions and ... Bottom Line
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Bottom Line  |   December 01, 2005
Medicare CCI Edits Extended to All Providers
Author Notes
  • Mark Kander, ASHA’s director of health care regulatory analysis, can be contacted at mkander@asha.org
    Mark Kander, ASHA’s director of health care regulatory analysis, can be contacted at mkander@asha.org×
Article Information
Practice Management / Bottom Line
Bottom Line   |   December 01, 2005
Medicare CCI Edits Extended to All Providers
The ASHA Leader, December 2005, Vol. 10, 3-20. doi:10.1044/leader.BML1.10172005.3
The ASHA Leader, December 2005, Vol. 10, 3-20. doi:10.1044/leader.BML1.10172005.3
Medicare billing edits, administered by the National Correct Coding Initiative (NCCI or, more commonly, CCI), restricts certain pairs of evaluation and/or treatment procedures from being billed on the same day for the same patient. With the edits being extended to all provider settings on Jan. 1, the following questions and answers are provided to help clinicians with their Medicare billing.
Q: What’s new about CCI edits in 2006?
Effective Jan. 1, CCI edits will be extended to Medicare Part B services in skilled nursing facilities, comprehensive outpatient rehabilitation facilities, rehabilitation agencies, and home health agency outpatient clinics. Since 1996 they had been applied to Part B services only in physician offices and hospital outpatient clinics.
Q: Will Medicare cover speech-language pathology services related to an SGD?
“Mutually exclusive” code pairings and codes are considered to be components of more comprehensive services or otherwise inappropriate to be delivered to the same patient on the same day. An example of an audiology CCI edit pair is Current Procedural Terminology (CPT*) 92555 (speech threshold audiometry) and CPT 92557 (comprehensive audiometry) because the former procedure is included in the latter. A speech-language pathology edit pair is CPT 92607 (evaluation for prescription for speech-generating device) and CPT 92506 (speech-language evaluation).
Q: Can I request an exception to a specific pair?
Yes. Some code pairs edits may be negated by the addition of a modifier -59. The modifier is added to a designated CPT code on the billing form. An example is the speech-language pathology pair mentioned above. The -59 modifier would indicate that the two evaluations (92607 and 92506) are separate and distinct. The medical record, in this case, should clearly show that the speech-language pathologist needed first to determine that the client’s speaking needs could not be met using natural communication methods. The audiology example above does not allow use of the -59 modifier.
Q: How can I find out if the -59 is available to override the edit?
The ASHA Web site (www.asha.org/practice/reimbursement/coding/CCI_edits_Aud.htm or . . . edits_SLP.htm ) contains a complete list of relevant code edit pairs and rules for using the -59 modifier. The separate tables for audiology and speech-language pathology clearly indicate when the -59 modifier is available.
Q: Where can I find CCI edits for all medical disciplines?
The complete list of CCI edits, developed by the Centers for Medicare and Medicaid Services (CMS), is found on the CMS Web site. For each pair, the last column contains a “modifier indicator”:
  • 0 = No CPT modifier can be used to bypass the edit pair.

  • 1 = A CPT modifier can be used to allow payment for both codes. For audiologists and speech-language pathologists, -59 is the modifier to use, when appropriate.

  • 9 = The code pair has been deleted from the CCI system.

The national edits are revised quarterly and may be implemented by Medicaid programs at the option of each state.
* CPT © 2004 American Medical Association. All Rights Reserved.
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December 2005
Volume 10, Issue 17