NCCI.V17.0.CCI.CR.1.1.2011.R2097CP.pdf

CMS Manual System Department of Health & Human Services (DHHS)

Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS)

Transmittal 2097 Date: November 19, 2010

Change Request 7210

SUBJECT: Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 17.0, Effective January 1, 2011

I. SUMMARY OF CHANGES: This is the normal update to the CCI procedure to procedure edits. The attached Recurring Update Notification applies to chapter 23, section 20.9.

EFFECTIVE DATE: *January 1, 2011 IMPLEMENTATION DATE: January 3, 2011

Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.

II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated)

R=REVISED, N=NEW, D=DELETED-

R/N/D CHAPTER / SECTION / SUBSECTION / TITLE

N/A

III. FUNDING:

For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs) and/or Carriers:

No additional funding will be provided by CMS; Contractor activities are to be carried out within their operating budgets.

For Medicare Administrative Contractors (MACs):

The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

IV. ATTACHMENT:

Recurring Update Notification

*Unless otherwise specified, the effective date is the date of service.

Attachment – Recurring Update Notification

Pub. 100-04 Transmittal: 2097 Date: November 19, 2010 Change Request: 7210

SUBJECT: Quarterly Update to Correct Coding Initiative (CCI) Edits, Version 17.0, Effective January 1, 2011

Effective Date: January 1, 2011

Implementation Date: January 3, 2011

I. GENERAL INFORMATION

A. Background: The Centers for Medicare & Medicaid Services developed the National CCI to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Part B claims.

The latest package of (CCI) edits, Version 17.0, effective January 1, 2011, will be available via the CMS Data Center (CDC). A test file will be available on or about November 2, 2010, and a final file will be available on or about November 17, 2010.

Version 17.0 will include all previous versions and updates from January 1, 1996, to the present and will be organized in two tables: Column I/Column 2 Correct Coding Edits and Mutually Exclusive Code (MEC) Edits.

B. Policy: The coding policies developed are based on coding conventions defined in the American

Medical Association’s Current Procedural Terminology manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practice and review of current coding practice.

II. BUSINESS REQUIREMENTS TABLE

Number Requirement Responsibility (place an “X” in each applicable column) A

B

M A C

D M E

A C

F I

C A R R I E R

R H H I

Shared- System

Maintainers

OTH

ER

F I S S

M C S

V M S

C W F

7210.1 The regional office correct coding initiative

representatives (RO CCI) shall access the file from the CDC in the same manner they downloaded the previous versions. The filenames for the regions are:

RO

A B

M A C

D

C

F I

C A R R I E R

R H H I

Shared- System

Maintainers

OTH

ER

F I S S

M C S

V M S

C W F

Test File:

MU00.@BF12372.CCIALL.MEEDITS.TEST01.V170

MU00.@BF12372.CCIALL.CMPEDITS.TEST01.V170

Final File:

MU00.@BF12372.CCIALL.MEEDITS.FINAL01.V170

MU00.@BF12372.CCIALL.CMPEDITS.FINAL01.V170

7210.2 Contractors shall use the specific job control language in order to access Version 17.0 through the Network Data Mover and load the files into the system. The filenames for the contractors are:

Test File:

MU00.@BF12372.CCINDM.MEEDITS.TEST01.V170

MU00.@BF12372.CCINDM.CMPEDITS.TEST01.V170

Final File:

MU00.@BF12372.CCINDM.MEEDITS.FINAL01.V170

MU00.@BF12372.CCINDM.CMPEDITS.FINAL01.V17

X X X

7210.3 The CCI adds, deletes, and modifier indicator change lists will be forthcoming from the NCCI contractor to CMS via electronic mail, on or about November 24, 2010. The contractors shall receive the change reports via JSM/TDL from CMS 5 – 7 days later.

X X X

7210.4 Contractors shall maintain the CCI and MEC file formats contained in Pub. 100-04, Medicare Claims Processing Manual, chapter 23, section 20.9.

X X X

7210.5 Contractors shall not search their files to either retract payment or to retroactively pay claims.

X X X

7210.6 Contractors shall adjust claims if they are brought to their attention.

X X X

7210.7 If contractors foresee any problems with loading the CCI files, they shall load the files 2-3 days prior to the effective date (including weekends).

mailto:MU00.@BF12372.CCIALL.MEEDITS.TEST01.V1� mailto:MU00.@BF12372.CCIALL.CMPEDITS.TEST01.V161� mailto:MU00.@BF12372.CCIALL.MEEDITS.FINAL01.V162� mailto:MU00.@BF12372.CCIALL.CMPEDITS.FINAL01.V162� mailto:MU00.@BF12372.CCINDM.MEEDITS.TEST01.V1� mailto:MU00.@BF12372.CCINDM.CMPEDITS.TEST01.V162� mailto:MU00.@BF12372.CCINDM.MEEDITS.FINAL01.V162� mailto:MU00.@BF12372.CCINDM.CMPEDITS.FINAL01.V162�

III. PROVIDER EDUCATION TABLE

A

B

M A C

D

C

F I

C A R R I E R

R H H I

Shared- System

Maintainers

OTH

ER

F I S S

M C S

V M S

C W F

7210.8 A provider education article related to this instruction will be available at http://www.cms.hhs.gov/MLNMattersArticles/ shortly after the CR is released. You will receive notification of the article release via the established "MLN Matters" listserv. Contractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. In addition, the provider education article shall be included in your next regularly scheduled bulletin. Contractors are free to supplement MLN Matters articles with localized information that would benefit their provider community in billing and administering the Medicare program correctly.

IV. SUPPORTING INFORMATION

Section A: For any recommendations and supporting information associated with listed requirements, use the box below: N/A

X-Ref Requirement Number

Recommendations or other supporting information:

Section B: For all other recommendations and supporting information, use this space: N/A

V. CONTACTS

Pre-Implementation Contact(s): Val Allen, 410-786-7443, Valeria.Allen@cms.hhs.gov

Post-Implementation Contact(s): Val Allen, 410-786-7443, Valeria.Allen@cms.hhs.gov http://www.cms.hhs.gov/MLNMattersArticles/� mailto:Valeria.Allen@cms.hhs.gov� mailto:Valeria.Allen@cms.hhs.gov�

VI. FUNDING

Section A: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs), and/or Carriers:

No additional funding will be provided by CMS; contractor activities are to be carried out within their operating budgets.

Section B: For Medicare Administrative Contractors (MACs), include the following statement:

The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.