CCI Manual 2013: CCI manual gives carriers the power to set add-on edits, issues EMG guidance

Why This Topic Matters

The article highlights CCI manual updates that can affect claim acceptance, bundling, and payer-specific edits. It helps readers identify areas where Medicare and private carrier rules may diverge and where coding workflows may need review.

Article Sections

1. Carrier specific add-on edits

   Discusses the introduction of new add-on edit tables and the general way they interact with primary and secondary services. It also notes that payer policies may differ for some categories of add-on services.

2. Same day post-op E/M visits

   Covers guidance related to evaluation and management services reported during a postoperative period on the same day as a surgical procedure. It also notes the role of diagnosis coding and potential payer variability.

3. Epidurals forbidden for anesthesia

   Summarizes anesthesia-related restrictions addressed in the manual and the expanded scope of the limitation. The section focuses on how the guidance changed from prior manual language.

4. No new information for nerve conduction studies

   Reviews the manual’s discussion of nerve conduction study coding and references related deleted codes. It also notes the manual’s reminder about testing performed during surgery.

5. Anesthesia providers should note

   Highlights guidance on intraoperative neurophysiology testing in the anesthesia context. The section centers on who may not report the service under the manual’s guidance.

6. Bilateral chemodenervation of facial muscles

   Addresses reporting guidance for a revised facial muscle chemodenervation code when the procedure is performed on both sides. It also references bilateral procedure reporting conventions.

7. Avoid needle electromyography errors

   Summarizes the manual’s discussion of needle EMG add-on reporting limits and medically unlikely edit concerns. It also touches on the possibility of payer-specific rules.

8. Carrier conflicts may emerge

   Notes that private carrier policies may differ from general guidance for the service discussed immediately before. The section emphasizes the possibility of payer-specific claim handling.

9. Don’t unbundle urine drug screens

   Covers the manual’s bundling guidance for urine drug screening services when more than one type of test is performed in the same encounter. The section focuses on claim coding and bundling context.