Know what differentiates CCI and OCE edits

by James Smith
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The Correct Coding Initiative (CCI) edits for evaluation and management (E&M), including critical care, apply to hospitals effective January 1, 2009. Prior to this, not all CCI edits that applied to physician services also applied to comparable hospital services. Particularly those CCI edits that applied to physician E&M services (including critical care) were not incorporated into the Outpatient Code Editor (OCE) for application to hospital E&M services.

Correct Coding Initiative (CCI)to promote correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. It is 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 purpose of the CCI edits is to prevent improper payment when incorrect code combinations are reported.

For the uninitiated, OCE is a software package supplied to the physical intermediary by Centers for Medicare and Medicaid Services. These are updated quarterly.

Difference between CCI edits and OCE edits:

• CCI edits are used to process carrier-related claims while OCE edits are used to process fiscal intermediary (hospital outpatient). 
• Many CCI edits are included in the OCE. The OCE edits are used exclusively under the hospital OPPS – they are not used within the Medicare Physician Fee Schedule 

The CCI edits always comprise pairs of HCPCS codes and are arranged in two tables – column one/column two correct coding edits table. The CCI policy manual for Medicare encompasses a table of contents, an introduction and 13 narrative chapters.

The OCE edits are arranged in numeric order with descriptions for each edit, along with a claim disposition for each edit column one/ column two CCI edits table.

We provide you simple, instant connection to official code descriptors & guidelines and other tools for ICD-9 coding, CCI edits that help coders and billers to excel in the work they do every day.