CCI version 21.3: Watch for new CCI edits for shoulder bone excision codes

Why This Topic Matters

The updates can affect claim editing, payment, and edit override options for procedures commonly reported in orthopedic and outpatient settings. Understanding the scope of the changes helps reduce denials and supports compliant billing when multiple services occur on the same date of service.

Article Sections

1. Shoulder and related CCI edits

   Discusses new Medicare CCI pairings involving shoulder prosthesis removal and several related excision procedures. Also covers revision and arthrotomy-related edits in the same general area of care.

2. Other new CCI edits

   Summarizes additional CCI bundling changes affecting soft tissue, skin, biopsy, and blood draw procedures. Includes a brief example involving services on separate problems.

3. MUEs limit J code, fracture treatment

   Describes new medically unlikely edits affecting a hyaluronic acid injection code and a fracture treatment code. Notes the effective date and the general impact on per-day billing limits.