MLN Matters® Number: MM7802
Related Change Request (CR) #: CR 7802
Related CR Release Date: March 30, 2012
Effective Date: July 1, 2012
Related CR Transmittal #:R2434CP
Implementation Date: July 2, 2012
Provider Types Affected
This MLN Matters® Article is intended for physicians submitting claims to Medicare Carriers and/or A/B Medicare Administrative Contractors (A/B MACs) for services provided to Medicare beneficiaries.
Provider Action Needed
This article is based on Change Request (CR) 7802, which provides a reminder for physicians to take note of the quarterly updates to Correct Coding Initiative (CCI) edits. The last quarterly release of the edit module was issued in April 2012.
The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (CCI) to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Part B claims.
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
- Review of current coding practice
The latest package of CCI edits, Version 18.2, is effective July 1, 2012, and includes all previous
versions and updates from January 1, 1996, to the present. It will be organized in two tables:
- Column I/Column 2 Correct Coding Edits
- Mutually Exclusive Code (MEC) Edits
Additional information about the CCI, including the current CCI and Mutually Exclusive Code (MEC) edits, is available at www.cms.gov/NationalCorrectCodInitEd on the CMS Web site.
The CCI and MEC file formats are defined in the 'Medicare Claims Processing Manual,' (Chapter 23, Section 20.9), which is available at www.cms.gov/manuals/downloads/clm104c23.pdf on the CMS Web site.
The official instruction, CR 7802, issued to your Carrier or and A/B MAC regarding this change may be viewed at www.cms.gov/Transmittals/downloads/R2434CP.pdf release on the CMS Web site.
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. CPT only copyright 2011 American Medical Association.