PART B MYTHBUSTERS: Just Because CCI Doesn't 'Bundle' Procedures Doesn't Mean You Can Always Bill Them Together

Why This Topic Matters

It helps coders and compliance staff avoid overreliance on automated edit systems and recognize that payment alone does not necessarily confirm correct coding. The article also highlights the potential for audit or fraud scrutiny when claims are submitted based on assumptions instead of documented coding principles.

Article Sections

1. Turn To Your CCI Manual

   This section discusses the role of the Medicare Correct Coding Initiative manual and its relationship to broader coding guidance. It emphasizes that published edits are not the only source of coding policy considerations.

2. Watch For Fraud Potential

   This section addresses post-payment review risk and the possibility of fraud allegations related to coding combinations. It frames the issue in terms of compliance exposure and audit scrutiny.