For claims processed on or after December 7, 2022, you may notice differences related to changes in code pairs in CCI, which includes modifier override changes; daily frequency limits; incidental, mutually exclusive and unbundled code edits; assistant surgeon eligibility; modifier to procedure compatibility; evaluation of incomplete diagnosis; global surgery pre-operative and post-operative periods as defined by CMS; and other standard coding code edits. Here is a high level summary of some of the changes. This is not an all-inclusive list.
CCI v28.3 and OCE_CCI v28.3 additions, deletions, expirations and changes including when modifier overrides are allowable per CMS guidelines.
|Denied Code||Description||Paid Code||Description|
|76770||Complete Ultrasound Scan Behind Abdominal Cavity||76700, 76705||Complete Ultrasound Scan Of Abdomen, Limited Ultrasound Scan Of Abdomen|
|76775||Limited Ultrasound Scan Behind Abdominal Cavity||76700, 76705||Complete Ultrasound Scan Of Abdomen, Limited Ultrasound Scan Of Abdomen|
For reference to the claims-processing rules currently in place and significant customization, please refer to the Code Auditing Rules and Customization, 1550/20.000162 payment policy.
As a reminder, Clear Claim Connection is available on the CDPHP Secure Provider Portal. This claims editing tool allows providers to enter a specific coding scenario and view the editing results in place on the date of the inquiry. If a denial is issued for the coding scenario, the rationale for the denial is provided. The results of a coding inquiry may differ from the results of an actual claim payment as a claim may be affected by other factors, such as member eligibility or other claim processing and/or pricing logic.
For more information, please call CDPHP Provider Services at (518) 641-3500 or 1-800-926-7526.