Effective January 1st, 2014, the California Division of Workers’ Compensation (DWC) adopted The National Correct Coding Initiative (NCCI) Edits, including Medically Unlikely Edits.
CCI edits occur when two procedure codes are incorrectly billed together. A Medically Unlikely Edit (MUE) occurs when an erroneous number of units is assigned to a procedure code. Both CCI edits and MUEs result in a $0 reimbursement only for the incorrectly billed procedure code.
CCI & MUE Summarized
- CCI Edit: A combination of procedure codes violates Correct Coding Initiative (CCI)
- MUE: The number of units assigned a procedure code violates Medically Unlikely Edits (MUE)
In the example below, a CCI edit is applied to procedure code 99214, reducing the reimbursement to $0. Per the NCCI message, procedure code 99214 is erroneously billed with surgical procedure code 29806.
In the example below, an MUE edit is applied to procedure code 99214 which is billed with three units. Per the NCCI message, only two units of service are allowed for this procedure code. The MUE edit reduces the reimbursement to $0.
California Code of Regulations (CCR)
Division of Workers’ Compensation Websites
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