January 2007
Provider Types Affected
Physicians who submit claims to Medicare carriers and A/B Medicare Administrative Contractors (A/B MACs)
Background
This article and related Change Request (CR) 5422 provide a reminder for physicians to take note of the quarterly updates to the coding initiatives. The latest package of Correct Coding Initiative (CCI) edits, Version 13.0, effective January 1, 2007, will be available via the CMS Data Center (CDC).
Physicians may view the current CCI edits and the current Mutually Exclusive Code (MEC) edits at http://www.cms.hhs.gov/NationalCorrectCodInitEd/ on the Centers for Medicare & Medicaid Services (CMS) website.
The National Correct Coding Initiative developed by 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 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. The latest package of CCI edits, Version 13.0, is effective on January 1, 2007. This version will include all previous versions and updates from January 1, 1996 to the present and will be organized in two tables:
Additional Information
The CCI and MEC file formats will be maintained in the Medicare Claims Processing Manual (Publication 100-04), Chapter 23, Section 20.9, which can be found at http://www.cms.hhs.gov/Manuals/IOM/list.asp on the CMS website.
You may see the official instruction (CR5422) issued to your Medicare carrier or A/B MAC by going to http://www.cms.hhs.gov/Transmittals/downloads/R1124CP.pdf on the CMS website.
If you have any questions, please contact your state's Provider Contact Center.
MLN Matters MM5422