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§ 9789.12.13 Correct Coding Initiative

Summary

Effective January 1st, 2014, the California Division of Workers’ Compensation (DWC) adapted The National Correct Coding Initiative 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:

  1. CCI Edit: A combination of procedure codes violates Correct Coding Initiative (CCI).
  2. MUE: The number of units assigned a procedure code violates Medically Unlikely Edits (MUE).

Examples

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.

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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.

 

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California Code of Regulations (CCR)

§ 9789.12.13 Correct Coding Initiative

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

DaisyBill Solution

To save you time, the DaisyBill Work Comp Wizard automatically displays and calculates CCI edits and MUEs for every fee calculation. Sign up for the DaisyBill Work Comp Wizard and instantly start billing easier. Click below for a FREE three day trial and start easy calculations today.

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