The Medicare payment process instituted a series of edits designed to promote correct coding methodologies and eliminate improper coding on January 1, 2006. These edits are known as the Correct Coding Initiative Edits (CCI Edits). This update provides the ability to review Part B claims and edit them in order to comply with the newly enacted CCI Edit requirements.

The most common CCI Edit is the edit that requires a modifier code '59' when two distinct procedural services for the same patient on the same day are provided by the by the same provider.

The CCI Edits Table File [CTF, 8, 29]:

A table has been supplied with Patch #23 that contains a list on the most common HCPCS codes that would require a modifier '59' to inform Medicare that the services provided are distinct.

The CCI Edits table [CTF, 8, 29]  screen appears below:

							(223-HRM)
				HCPCS Requiring Modifier

  HCPCS Code: 92507 2nd Key: 92507.▬▬▬ Description: SPEECH THERAPY    

				Default Modifier for this HCPCS: 59

				Secondary
				HCPCS Code
				97110 ▬▬▬▬▬
				97112 ▬▬▬▬▬
				97150 ▬▬▬▬▬
				97530 ▬▬▬▬▬
				95532 ▬▬▬▬▬
				▬▬▬▬▬ ▬▬▬▬▬
				▬▬▬▬▬ ▬▬▬▬▬
				▬▬▬▬▬ ▬▬▬▬▬

	Enter (F) to File (I) to Ignore: F

In the above example, whenever the Primary HCPCS code '92507' is present and one of the listed secondary codes are also present on the same day, a modifier code '59' would be required for the secondary HCPCS code in order to be approved for payment.

The client can review this table and add additional HCPCS codes as they become needed.

The CCI Edits Program [AR, 2, 10, 11]:

This program should be run after all ancillary charges have been posted, but before UB92 Part B bills are sent to Medicare.

The CCI Edits Program  [AR,2, 10,11]  screen appears below:

  

	      	CPT Coding Edits for HCPCS Modifiers


  Resident Range : A▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ ZZZ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬

  Service Dates : 05/01/06 - 05/31/06     Revenue Codes : 420 - 449    

  (P)reliminary Listing/(U)pdate: U

  Print Option: P

The 'Preliminary' option prints a report showing all CCI Edits that need to be reviewed. When using the 'Update' option, the program will display all CCI Edits issues that are encountered. The program will list all HCPCS codes that require a modifier code '59' on the screen and insert that modifier into the ancillary charge. If you wish to accept the '59' modifier press 'Enter'. If you wish to remove the '59' modifier simply delete the '59' modifier from the screen. A report of all items updated is also printed. If no edits are encountered the program will exit back to the main menu. At this time you are ready to submit your Part B bills.

Using Update - an example of a CCI Edit issue displayed on your the screen:

   
			   CCI EDITS

  Resident : Test,Resident

  Service Date 	Primary HCPCS 	   Secondary HCPCS 	Modifiers     

  01/01/2006 	  92507 	*     97110		59 __
							

The Medicare UB92 programs have also been modified to allow for a third modifier if required.

Please note that if you are using PC Ace - only two modifiers are available to be interfaced from CHARTS to PC Ace.

If you have any additional questions please feel free to call client service at (718) 338-2400.

END