Get Ready for 99,490 New CCI Edits Coming January 1

CCI update January 2017

January 1 means new CPT® and HCPCS codes, and one consequence of that is a whole lot of changes to National Correct Coding Initiative edits (aka NCCI edits or CCI edits). While every quarter brings updates to CCI edits, the changes to the January version tend to be pretty numerous because they have to incorporate new edits for the new codes and delete edits for whatever codes were deleted for the year.

Helpful: CMS now provides a spreadsheet each quarter that shows just the changes, with one tab for additions, one tab for deletions, and one tab for modifier indicator changes. While working from the spreadsheet (instead of the official version or a trusted CCI Edits Checker) isn’t recommended, reviewing the changes-only file is a great way to spot patterns in the edits. Here are a few patterns you’ll see in the CCI edits going into effect on Jan. 1, 2017.

Focus on Spinal Injections and Moderate Sedation for Additions

The spreadsheet shows 99, 490 CCI edit additions for Jan. 1, so we won’t be going through them all here! But you can definitely pick up trends about what’s getting bundled, and chances are you won’t be too surprised. Over and over again, you’ll see these codes in the Column 2 position:

  • 62320-62327, interlaminar epidural or subarachnoid injections
  • 99151-99153, moderate sedation by different provider that the one doing the surgery
    • Tip: Codes 99151-99153 are mostly bundled into other anesthesia codes (0xxxx), rather than into procedure codes
  • 99155-99157, moderate sedation by same provider who’s doing surgery.

There are plenty of other additions, too, such as the usual bundling of integumentary system codes into new surgical procedure codes and bundling of radiology codes into new codes that specifically include imaging guidance, so be sure to check the edits for the codes related to your specialty.

Deletions: As you may have guessed, the 55,760 deletions have a pattern, too. The deletions remove edits for 62310-62319 (which 62320-62327 replace) and 99143-99150 (which 99151-99157 replace).

Always Check the Modifier Indicator Changes

The tab showing modifier indicator changes is an important one because it shows existing edits that have new reporting rules. You’ll see which edits have been changed from modifier indicator 0 (meaning you may never override the edit) to modifier indicator 1 (which means you may override the edit when documentation supports doing so), and vice versa.

Here’s an overview of the modifier indicator changes listed in the spreadsheet for Jan. 1, 2017. This list is intended as a summary only, so check the individual edits before making any coding decisions.

Change from 0 to 1 (may override):

  • Edits bundling paravertebral block codes 64461 and 64463 into trigger point injection codes 20552 and 20553
  • Edits bundling A95xx radiopharmaceutical codes into certain 783xx and 788xx nuclear medicine codes
  • Edits bundling 95941 and G0453 (intraoperative neurophysiology monitoring from outside the OR) into 95940 (intraoperative neurophysiology monitoring from inside the OR)

Change from 1 to 0 (may NOT override):

  • The laryngoscopy edit bundling biopsy code 31576 into lesion removal code 31578
  • Edits involving 6158x and 6159x codes for skull base surgical procedures

How About You?

Are any of these CCI edits a surprise, or do they create CCI bundles you don’t agree with?

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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1 Comments For This Post

  1. Julian Cunningham Says:

    THANK you For the updates. I am scheduled to take CCA in the next week or so. AHIMA is not requiring the 2017 CPT, but the 2016 CPT. I am just thankful for your blog. Hopefully I will pass the exam. Then, I will purchase the 2017 as needed, and I am praying for a job. I will mot be able to receive any emails because I am shipping my computer off for repairs.

    Sincerely Yours,
    Julian Cunningham

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    […] January 1 means new CPT® and HCPCS codes, and one consequence of that is a whole lot of changes to National Correct Coding Initiative edits (aka NCCI edits or CCI edits). While every quarter brings updates to CCI edits, the changes to the January version tend to be pretty numerous because they have to incorporate new edits for the new codes and delete edits for whatever codes were deleted for the year.  […]

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