Look Ahead to These 3 Trends for April 2019 CCI Updates

prepare the team for April CCI updates

Think Medicare’s April CCI updates are small potatoes? You may reevaluate that stance when you learn there are more than 11,000 additions planned for April 1, 2019. To help make it manageable, watch the three areas below.

Our focus: The topic here is Medicare practitioner procedure-to-procedure (PTP) Correct Coding Initiative (CCI) edits that will be added April 1, 2019.

First, Some CCI July News About Modifier Placement

Because we’re talking about CCI, it’s a good time to mention a recent announcement from Medicare about bypassing CCI edits.

Currently when you use modifier 59, XE, XS, XP, or XU to override an edit, Medicare’s Multi-Carrier System (MCS) requires you to place the modifier on the column two code of the CCI PTP edit pair. Starting July 1, 2019, Medicare has stated that the MCS will accept these modifiers on either the column one or column two code to bypass the edit. The edit will still need to have a modifier indicator of 1 for you to consider overriding the edit based on the documentation.

Remember the date: The plan is for that change to be effective July 1, 2019. (We’re talking about April updates below, so don’t get confused!)

Now, 3 Top Areas for April CCI Additions

With so many additions to the CCI edits, we can’t go over each one (that’s why you need an easy way to check CCI edits). But there are a few overarching themes to watch for.

  • 96523 irrigation: The major player in the additions is 96523 (Irrigation of implanted venous access device for drug delivery systems). It is the column two code in more than 9,400 new edits, effective April 1. The good news is that this change should not affect your coding because CPT® guidelines instruct you not to report 96523 in conjunction with other services. So the new CCI edits just help you make sure you follow that rule.
  • Path/lab codes: Another large chunk of the edits include codes for MAAA administrative codes (ending with M), PLA codes (ending with U), and Category I 80000 codes. Don’t make assumptions about column one and column two codes for these edits. For instance, 0070U is the column two code in an edit with 81460. But 0070U is the column one code in an edit with 87496.
  • Lesion removal: Many of the edits feature 113xx codes for shaving of epidermal or dermal lesions and 17xxx codes for destruction procedures on benign or premalignant integumentary lesions. To allow for reporting these bundled procedures on distinct body parts, you can expect to see a modifier indicator of 1 for these edits.

Tip: In some cases, the additions and deletions are actually column switches. For instance, 17000/11200 will be deleted, but 11200/17000 will be added as an edit. So the codes are still in an edit pair, but the codes swap columns.

What About You?

Do you tend to have your top CCI edits memorized, or do you always confirm edits before reporting to make sure you didn’t miss column swaps and modifier indicator changes?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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