Health Information Management

New CPT codes not available in CCI edits until April 1

APCs Insider, January 30, 2009

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Q: Beginning with January 1, 2009 dates of services (DOS), we noticed that the drug administration CPT codes are not hitting CCI edits as they did before (with modifier -59 application when appropriate). Can you explain what’s happening and provide an update?
 
A: Your observation is correct. Being observant of the 2009 outpatient revenue cycle, OPPS and claim submission for 2009 shows you’re being compliant.
 
Because hospital CCI edits run one quarter behind the physicians, the new CPT codes for drug administration services are not available in NCCI Version 14.3, which is effective January 1 through March 30th.
 
Now, why are they not edited in the version? Version 14.3 has the 2008 CPT codes loaded. The new 2009 CPT codes won’t appear in the edits until the next version. They cannot be identified within the CCI edits and thus won’t trigger edits. Version 15.0, effective April 1, 2009, will contain the new CPT codes which will then be identified for CCI edits much as we have seen in recent years.
 
 Reviewing the 2009 first quarter Medicare outpatient claims that contain drug administration codes for any bundling policies that apply but are not included in the NCCI edits is extremely important. Review claims to ensure complete documentation and adherence to the facility drug administration hierarchy rules and reliable claims submission. This ensures APC revenue integrity and compliance with applicable CPT coding policies.
 
Also be on the lookout for updated CCI edits for critical care services as published in the 2009 OPPS final rule.



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