Medical Insurance Chapter 6 Visit Charges
and Compliant Billing
Code Linkage - ANS -Connection between a service and a patient's condition or illness.
The CPT procedure codes match the ICD-10-CM diagnosis code.
Correct Coding Initiative (CCI) - ANS -Computerized Medicare system that controls improper
coding that would lead to inappropriate payment for Medicare claims
CCI coding policies are based on - ANS -Coding conventions in CPT
Medicare's national and local coverage and payment policies
National medical societies' coding guidelines
Medicare's analysis of standard medical and surgical practice
CCI Edits - ANS -Computerized system that identifies improper or incorrect codes
CCI Edits are organized into the following categories: - ANS -Column 1/column 2 code pair
edits
Mutually exclusive code edits
Modifier indicators
CCI column 1/ column 2 code pair Edits - ANS -Medicare code editor where CPT codes in
column 2 will not be paid if reported on the same day as the column 1 code.
CCI mutually exclusive code (MEC) edit - ANS -Both services represented by MEC codes that
could not have been done during one encounter
CCI modifier indicator - ANS -Number showing whether the use of a modifier can bypass a CCI
edit.
Medically unlikely edits (MUEs) - ANS -Units of service edits used to lower the Medicare
fee-for-service paid claims error rate.
Office of Inspector General (OIG). OIG Work Plan - ANS -OIG's annual list of planned projects
Advisory opinion - ANS -Opinion issued by CMS or OIG that becomes legal advice
Excluded parties - ANS -Individuals or companies not permitted to participate in federal
healthcare programs
and Compliant Billing
Code Linkage - ANS -Connection between a service and a patient's condition or illness.
The CPT procedure codes match the ICD-10-CM diagnosis code.
Correct Coding Initiative (CCI) - ANS -Computerized Medicare system that controls improper
coding that would lead to inappropriate payment for Medicare claims
CCI coding policies are based on - ANS -Coding conventions in CPT
Medicare's national and local coverage and payment policies
National medical societies' coding guidelines
Medicare's analysis of standard medical and surgical practice
CCI Edits - ANS -Computerized system that identifies improper or incorrect codes
CCI Edits are organized into the following categories: - ANS -Column 1/column 2 code pair
edits
Mutually exclusive code edits
Modifier indicators
CCI column 1/ column 2 code pair Edits - ANS -Medicare code editor where CPT codes in
column 2 will not be paid if reported on the same day as the column 1 code.
CCI mutually exclusive code (MEC) edit - ANS -Both services represented by MEC codes that
could not have been done during one encounter
CCI modifier indicator - ANS -Number showing whether the use of a modifier can bypass a CCI
edit.
Medically unlikely edits (MUEs) - ANS -Units of service edits used to lower the Medicare
fee-for-service paid claims error rate.
Office of Inspector General (OIG). OIG Work Plan - ANS -OIG's annual list of planned projects
Advisory opinion - ANS -Opinion issued by CMS or OIG that becomes legal advice
Excluded parties - ANS -Individuals or companies not permitted to participate in federal
healthcare programs
