Posts Tagged swapped pairs


Frank Cohen Produces April 1, 2010 CCI Edit Analysis for Medicare Part B Claims

Here’s a refresher from CMS on NCCI for those of us experiencing acronym-exhaustion:

The CMS (Centers for Medicare and Medicaid Services) developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the American Medical Association’s CPT manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual).  The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits.

Carriers implemented NCCI edits within their claim processing systems for dates of service on or after January 1, 1996.  More information here.

If you’ve been reading my website for awhile, you know I’m a big Frank Cohen fan.  He espouses the idea of giving away lots of good free stuff and his work is topnotch!  If you’ve never taken one of his free webinars, do yourself a favor and tune in.  I don’t see any webinars on his website currently, but get on his mailing list and you’ll be the first to know when he’s offering them again.

As usual, he offers his analysis of the most recent CCI Edits.  Franks states:
Version 16.1 of the CCI edit database is scheduled to be effective on April 1, 2010. There are 2,054 new edit pairs effective for this release. 35 of these are effective retroactive to October 1, 2009. This means that if you billed for and were paid on one or more of these retroactive edits, you may be subject to repayment.
142 edit pairs are reported as terminated (no longer effective) for this release. Four are terminated retroactive to December 31, 2005; four are retroactive to December 31, 2006 and 76 are shown as terminated retroactive to December 31, 2007. I guess this means that if you were denied due to a CCI edit pair during these periods, you should be able to resubmit the claim and get paid.
You can expect 1,947 changes with respect to the modifier indicator with 1,892 going from an indicator of 0 (no modifier permitted) to an indicator of 1 (modifier permitted). 55 edit pairs report a change in the modifier indicator from a 1 to a 0.
In total, there are 1,337 duplicate edit pairs in the database. These are records that were made effective at one point, then terminated and then made effective again. There are also currently 5,309 swapped pairs. These are edit pairs that were introduced in one order (i.e., 99350 as column 1 and 96416 as column 2), terminated and then re-activated in the opposite order (i.e., 96416 as column 1 and 99350 as column 2).
For a worksheet that contains all of the changes, edits and updates, go to and click on the Download tab. It is the third link down the page.  Frank invites all readers to email him with any questions or comments to
Thanks, Frank!
Photo Credit: Mary Pat Whaley – taken at the Lone Star Barbeque and Mercantile in Santee, South Carolina (great food!)

Posted in: Medicare & Reimbursement, The Cohen Report (NCCI & RVUs)

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