| The Correct Coding Initiative (CCI) edits for | | | | national and local policies and edits, coding |
| evaluation and management (E&M), including | | | | guidelines developed by national societies, analysis |
| critical care, apply to hospitals effective January 1, | | | | of standard medical and surgical practices, and a |
| 2009. Prior to this, not all CCI edits that applied to | | | | review of current coding practices. The purpose |
| physician services also applied to comparable | | | | of the CCI edits is to prevent improper payment |
| hospital services. Particularly those CCI edits that | | | | when incorrect code combinations are reported. |
| applied to physician E&M services (including | | | | For the uninitiated, OCE is a software package |
| critical care) were not incorporated into the | | | | supplied to the physical intermediary by Centers |
| Outpatient Code Editor (OCE) for application to | | | | for Medicare and Medicaid Services. These are |
| hospital E&M services. | | | | updated quarterly. |
| Correct Coding Initiative (CCI)to promote correct | | | | Difference between CCI edits and OCE edits: |
| coding methodologies and to control improper | | | | CCI edits are used to process carrier-related |
| coding leading to inappropriate payment in Part B | | | | claims while OCE edits are used to process fiscal |
| claims. It is based on coding conventions defined in | | | | intermediary (hospital outpatient). |
| the American Medical Association's CPT manual, | | | | |