National Correct Coding Initiative: Audiology Edits
The National Correct Coding Initiative (NCCI, or more commonly, CCI) is an automated edit system to control specific Current Procedural Terminology (CPT) code pairs that can be reported on the same day. It was developed by the Centers for Medicare and Medicaid Services (CMS) for use in all Medicare Part B and, more recently, Medicaid claims. The goal of CCI 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. The CCI is updated quarterly.
An example of a mutually exclusive code pairing is 92601 (cochlear implant programming, under 7 years of age) and 92603 (cochlear programming, age 7 years or older). An example in the comprehensive/component list is 92555 (speech threshold audiometry) and 92557 (comprehensive audiometry).
A subset of the CCI edits is the Outpatient Code Editor (OCE), which applies only to hospital outpatient services. Typically, the OCE edits for audiology are similar to those in the CCI system. The OCE revisions also occur quarterly, but one quarter after the revised CCI edits are implemented.
The CCI also includes a set of edits called Medically Unlikely Edits (MUEs), also for Medicare Part B and Medicaid claims. An MUE for a CPT or HCPCS Level II code is the maximum number of times that the code can be reported for the same patient on the same day. Not all codes have an MUE and/or CCI edit.
Audiology Related Edits for Medicare
Full Lists of Edits from CMS
How to Read the CMS Edits
For those who visit the CMS CCI and OCE site, note that tables include a "modifier indicator" in the last column:
0 = No CPT modifier can be used to bypass the edit pair
1 = A CPT modifier can be used to bypass the edit pair and allow payment for both codes. For speech-language pathologists, "-59" is the modifier to use, when appropriate.
9 = The code pair has been deleted from the CCI or OCE system
The next to last column indicates the date the edit pair was deleted from the system, if applicable.