Health Information Management

Q/A: Wound care and NCCI edits

APCs Insider, March 11, 2011

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Q: We are almost to the second quarter of 2011. Medicare often updates the Integrated Outpatient Code Editor (I/OCE) and National Correct Coding Initiative (NCCI) edits for April. Has CMS made any updates to the NCCI edits for CPT® codes 97597 and 97598, since their definitions changed in January? What should facilities do next?

A: We have seen a Medicare Administrator Contractors (MAC) information alert indicating that MACs are holding outpatient claims with CPT codes 97597 and 95987 and that no provider action is required.
CMS has instructed contractors to hold outpatient claims with CPT codes 97597 and 97598 until the I/OCE file has been updated. The claims will be held until April 4.

Communicate with your patient financial services department and any other applicable departments (e.g., wound care, rehabilitative services) regarding this ongoing payment issue. Providers must remain alert with respect to this issue to be certain that the appropriate update works when claims are processed in April.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.



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