CMS Announces Change in
CCI Edits at ACA's Urging

This section is compiled by Frank M. Painter, D.C.
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April 1, 2002

Improved Chiropractic Coding Within CCI Edit Software

ARLINGTON, VA - The Centers for Medicare & Medicaid Services (CMS) has announced changes in its National Correct Coding Initiative (NCCI) that will allow doctors of chiropractic to use codes for procedures such as manual therapy (CPT Code 97140) when billed on the same date of service as a chiropractic manipulative treatment (CMT) code. The changes come after more than a year of lobbying by the American Chiropractic Association (ACA), which doggedly pursued CMS to reverse CCI edits that had spilled over from Medicare and negatively affected doctors of chiropractic in the private pay system.

The immediate impact of these changes will be the allowable use of 97140, 97124 and 97112 when billed in conjunction with CMT. As has been the case with 97140, it is now important to also add modifier -59 to codes 97112 and 97124. Due to private third party payers mirroring the old edits (NCCI version 8.0), doctors of chiropractic throughout the country were unable to bill 97140, 97124 and 97112 regardless of whether modifier -59 was utilized. The ACA views the current change to NCCI version 8.1, with respect to these codes and modifier -59, as a favorable outcome and a victory for the profession. However, there are still certain issues with these CCI edits that cause ACA concern, and the association will continue to work diligently to ensure that these are reversed in the next NCCI software version.

The ACA began lobbying CMS on this issue after doctors of chiropractic nationwide began experiencing increased claim denials from large national insurers for codes such as 97140 (manual therapy), 97124 (massage) and 97112 (neuromuscular re-education) when billed on the same date of service as a CMT code (98940-98942). Because private pay often mirrors Medicare, large national insurers were using the NCCI computer edit software systems and denying claims from doctors of chiropractic because they were "mutually exclusive with another procedure." However, many of these edits conflicted with correct CPT coding policy -- which differs from CCI -- and the ACA took strong action to try to alleviate this problem.

Although the change will not impact Medicare claims filed by doctors of chiropractic, the ACA hopes it will ensure that private insurers across the country do not misinterpret CPT policy when using NCCI edit software. "This change in NCCI will not impact payment of Medicare claims filed by chiropractors," Niles R. Rosen, MD, medical director of NCCI stated. "Since Medicare contractors have systems in place to assure that chiropractors are only paid for services billed as CPT codes 98940-98942. This restriction is based upon the requirements of Section 1832 of the Social Security Act and the Code of Federal Regulations at 42 CFR 410.22(b)(1) and (2)."

"Over the past year, the ACA has met with CMS officials to resolve this problem and has communicated with several large national insurers regarding their inappropriate use of CCI edits," said ACA President Dr. Daryl Wills. "We are extremely pleased that CMS has addressed our concerns, and we'll continue to monitor the situation in the private pay arena to ensure that doctors of chiropractic are being fairly reimbursed."

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