Professional CCI (Unbundling) Exclusion Maintenance

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Some payers have medical policy coding requirements that contradict existing code combinations contained in the National Correct Coding Initiative (CCI) code sets. Professional column 1 (comprehensive) and column 2 (component) procedure code combinations may be entered on this page for exclusion from edit 1002, CCI Unbundling of Services Identification.

REMINDER: Working payers must have been previously added via the Payer Maintenance page in order to be available on the Professional CCI (Unbundling) Exclusion Maintenance page.

To reach the Professional CCI (Unbundling) Exclusion Maintenance page, select Configuration from the ClaimStaker toolbar then CCI (Unbundling) Exclusion Maintenance then Professional.

To view exclusions created for all payers, select All Payers, Commercial or Otherwise from the drop-down menu. To view professional CCI exclusions for a specific working payer, select the desired payer from the Working Payer drop-down menu. Select the Get Exclusions button.

Screenshot of the Working Payer drop-down list on the Professional CCI (Unbundling) Exclusion Maintenance page. The payer, ABC Health Plan, has been selected and the Get Exculsions button is being selected.

Adding professional CCI exclusions

To add a new professional CCI exclusion, select the Add button on the Professional CCI (Unbundling) Exclusion Maintenance page. This opens the Add Professional CCI (Unbundling) Exclusion page.

TIP: Review any current entries for the payer before adding a new exclusion to ensure you are not duplicating an existing entry.

To create an exclusion:

  1. Enter the appropriate procedure codes in the Column 1 Procedure Code and Column 2 Procedure Code fields.

  2. Enter a comment for this exclusion in the Comment field if desired.

  3. Select the Apply button to save your new exclusion and return to the Professional CCI (Unbundling) Exclusion Maintenance page.

    Screenshot of the Exclusion Information section of the Professional CCI (Unbundling) Exclusion Maintenance page. There are three fields for adding exclusion information. The Column 1 Procedure Code field has procedure code 99383 entered. The Column 2 procedure Code field has procedure code 96150 entered. The Comment field is empty. The Apply button is being selected.

Your new professional CCI exclusion now appears in your list of exclusions.

Modifying professional CCI exclusions

Changes to professional CCI exclusions are made from the CCI (Unbundling) Exclusion Maintenance page. Exclusions may be sorted by selecting the CPT Primary, CPT Secondary, or Comment column header. Once you locate the exclusion to modify, select the icon under the Edit column for that exclusion.

Screenshot of the Professional CCI (Unbundling) Exclusion Maintenance page. There is a table with five columns and two rows. The column headers/names are CPT Primary, CPT Secondary, Comment, Edit, and Delete. The column names for CPT Primary, CPT Secondary, and Comment columns are underlined, indicating they can be sorted by being selected. The procedure codes in the rows under the CPT Primary column are 99211 and 99383. The procedure codes in the rows under the CPT Secondary column both have 96150. The rows under the Comment Field are empty. There are icons in the rows under the Edit and Delete columns. The Edit icon in the second row is being selected.

Selecting the Edit icon takes you to the Modify Professional CCI (Unbundling) Exclusion page where you can make changes to the exclusion. Simply enter the necessary modifications (such as adding a comment as shown below) and select the Apply button to save your changes and return to the Professional CCI (Unbundling) Exclusion page.

Screenshot of the Exclusion Information section of the Modify Professional CCI (Unbundling) Exclusion Maintenance page. There are three fields. The Column 1 Procedure Code field has procedure code 99383 entered. The Column 2 procedure Code field has procedure code 96150 entered. The Comment field a new comment that reads: This payer requires IHEBA/SHA codes for quality reporting. Override CCI edit.

Deleting professional CCI exclusions

To delete a professional CCI exclusion, select the icon for the exclusion under the Delete column on the Professional CCI (Unbundling) Exclusion Maintenance page.

Screenshot of the Professional CCI (Unbundling) Exclusion Maintenance page. There is a table with five columns and two rows. The column headers/names are CPT Primary, CPT Secondary, Comment, Edit, and Delete. The Delete icon in the second row is being selected.

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