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The National Correct Coding Initiative's (NCCI), more commonly known as CCI, edits are about to become widespread throughout Medicare. The automated Medicare edit system, established in 1996, controls specific Current Procedural Terminology (CPT)* code pairs that may be billed on the same day. Effective January 1, 2006, CCI edits will be extended from hospital and office-based settings to Medicare Part B services in other settings such as skilled nursing facilities, comprehensive outpatient rehabilitation facilities, rehabilitation agencies, and home health agency outpatient clinics.
CCI's goal is to eliminate "mutually exclusive" code pairings and codes 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 CPT 92555 (speech threshold audiometry) and CPT 92557 (comprehensive audiometry) because the CPT 92555 is a component of 92557.
An example of a speech-language pathology edit pair is CPT 92607 (evaluation for prescription for speech-generating device) and CPT 92506 (speech-language evaluation). This particular pair may be overridden by the addition of a modifier -59. The modifier indicates that the two evaluations are separate and distinct. The medical record, in this case, should clearly indicate that the speech-language pathologist had to first determine that the client's speaking needs could not be met using natural communication methods.
ASHA's Web site contains a complete list of relevant code edit pairs and rules for using the -59 modifier for both audiology and speech-language pathology procedures. The national edits are revised quarterly and may be implemented by Medicaid programs at the option of each state. For further information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, via e-mail at mkander@asha.org or by phone at 800-498-2071, ext. 4139.
* All CPT codes and descriptors are copyright 2004 American Medical Association
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