Skip Navigation LinksHome | Help
Help

When using CorrectCodeChek, you have several options to find codes and quickly determine if they are affected by bundling edits under the National Correct Coding Initiative (NCCI).

Code Search

To find all of the CCI edits associated with a particular code, enter the code you want into the Search Box where it says “Enter Code or Description.” Hit the enter button on your keyboard or click on the Black and White arrow box to the right of the code to see all of the CCI edits associated with that particular code.

The default setting is for the current quarter's edits. To change quarters, click on the drop down menu to the left of the search box. You must hit search again to bring up new results for a different quarter.

You can also find a code by choosing the “Index” option and entering a description of the code you are looking for. A list of possible matches will be displayed. Choose your code from that list to have it automatically entered into the search box.

Browse Codes

The “Browse codes” option, located to the right of the search box, allows you to pull up a list of all CPT or HCPCS codes broken down by procedure and service. Drill down through this list until you find the code you are looking for. Click on the code to add it to the search box.

Bundling Validation

To determine if a particular group of codes have bundling issues, use CorrectCodeChek’s Bundling Validation tool (immediately below the Code Search tool). This function allows you to enter up to twelve codes you intend to bill together and compares the codes against each other to determine if there are any CCI bundling issues or modifier requirements.

The Validation Results will break down each code, compare it to the other codes included, and provide you with an easy-to-read icon letting you know the status of the code pair.

  • A green checkmark means that there are no bundling issues between the two codes.
  • A yellow exclamation point means that there is a bundling issue and a modifier may be needed to differentiate the services provided.
  • A red X lets you know that you cannot bill these two codes together using any modifier.

Expert Guidance

As always, DecisionHealth provides you with expert guidance on newly released coding bundles broken down by quarter and arranged by specialty. You can access an archive of CCI Quarterly Updates by clicking on the link in the right column of the page. You’ll get a breakdown of all the CCI edits for each particular quarter, as well as a spreadsheet of all the bundled code pairs.

You can also access the official CCI Policy Manual to review the official Correct Coding Initiative guidelines.

Remember that CorrectCodeChek search results are copyrighted by DecisionHealth and may not be forwarded within your organization. If you have questions about the new CorrectCodeChek, please contact our customer service department at 1-855-CALL-DH1 (1-855-225-5341).

Understanding CCI Edits

The National Correct Coding Initiative (CCI), produced by the Centers for Medicare & Medicaid Services (CMS), tells you what procedures and services you can’t bill at the same time when they are furnished for the same patient on the same day.

When you look up a code in CorrectCodeChek, you will see columns of codes designated by an indicator. Column I is the list of comprehensive codes and Column 2 is the list of component codes. In the view of the National Correct Coding Initiative, the Column I (comprehensive) code includes all the services listed in Column 2 (the component codes).

In other words, if you provide services listed in both Column 1 and Column 2 to the same patient on the same day, you can bill only for the Column I (comprehensive) code unless the CCI allows you to use a modifier in order to bill a comprehensive code with one or more of its component codes.

PAYMENT IMPACT: If you bill for both a Column I code and Column 2 code (and no modifier is permitted), your Medicare carrier will deny your claim.

The CCI and CorrectCodeChek include code pairs that Medicare considers to be mutually exclusive. Mutually exclusive code pairs contain codes that CMS states cannot be reasonably performed by a physician in a single patient encounter. The mutually exclusive code pairs differ from the comprehensive-component code pairs in another way. Although the mutually exclusive codes are listed in Column I and Column 2 format, Column 2 codes are not a component of the Column I code. PAYMENT IMPACT: If you bill for a Column I and Column 2 mutually exclusive code for the same patient on the same day, Medicare will pay only the code with the lower reimbursement level (usually, but not always, the Column I code).

The modifier indicators tell you if you can bill separately for a Column I (comprehensive) code and Column 2 (component) code in special circumstances even though the codes are performed on the same patient on the same day. (Modifiers that identify these special cases are: E1-E4, FA, F1-F9, LC, LD, LT, RC, RT, TA, T1-T9, 25, 58, 59, 78, 79 and 91). Each unbillable code combination lists a modifier indicator of 0, 1 or 9. Here are CMS’s definitions of the modifier indicators:

0 Indicates that there are “no circumstances in which a modifier would be appropriate. The services represented by the code combination will not be paid separately.”

1 Indicates that “a modifier is allowed in order to differentiate between the services provided. Assuming the modifier is used correctly and appropriately, this specificity provides the basis upon which separate payment for the services billed may be considered justifiable.”

9 Means the edit has been deleted from the CCI and the modifier indicator is not relevant.

Login

User Name:
Password:
Welcome to the new CorrectCodeChek Online. If you are a returning user having trouble logging in, please click here.
Back to top