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 Correct Coding Initative

The purpose of the Correct Coding Initiative (CCI) is to detect inappropriate coding (unbundling) on Medicare claims and deny payment for them.

As of December, 1999, there were over 120,000 coding edits in Version 5.1 of the CCI.  Of these edits, 11,000 are considered “correct coding edits for mutually exclusive codes;” that is, those codes that represent services that cannot reasonably be performed in the same session.  The remaining 109,000 edits are classified as “correct coding edits for comprehensive codes” that represent various coding and payment policies where the “comprehensive” code will be paid and the “component” code disallowed. The edits are proprietary. Thus, physicians are not allowed to see them.

The AMA has fought for and has won an opportunity to comment on new CCI edits before they are implemented. ASSH volunteers routinely review and comment on new CCI edits prior to their release. For more information, contact Mitch Nahra, MD  of the ASSH Coding and Physician and Reimbursement Committee.

Last updated 1/10/2006