Corrective Coding Initiatives (CCI) edits are a set of coding rules established by the Centers for Medicare & Medicaid Services (CMS) to ensure accurate and consistent coding for billing and reimbursement purposes. These rules apply to all healthcare providers, including speech therapists, who submit claims for reimbursement to Medicare, Medicaid, and other insurance providers.
CCI edits are designed to identify pairs of codes that should not be billed together due to being considered mutually exclusive or considered components of a more comprehensive code. The CCI edits help prevent improper billing, overpayment, and potential fraud, and are periodically updated to reflect changes in coding practices and guidelines.
For speech therapy, CCI edits focus on ensuring that the services provided are billed accurately, without duplication or unbundling of services. Here are a few examples of CCI edits that may be relevant to speech therapy:
- Evaluation and treatment services: A speech-language evaluation (CPT code 92521-92524) should not be billed on the same day as a speech-language treatment session (CPT code 92507 or 92526). This is because the evaluation is considered part of the overall treatment plan and should be billed separately from the actual treatment sessions.
- Group and individual therapy: When providing group therapy services (CPT code 92508), individual therapy services (CPT code 92507) should not be billed for the same patient on the same day. This is to prevent double billing for the same service provided in different settings.
- Swallowing assessment and treatment: If a speech therapist conducts a clinical swallowing assessment (CPT code 92610) and also provides swallowing treatment (CPT code 92526) on the same day, the two services should not be billed separately. The swallowing assessment is considered a component of the swallowing treatment, and billing both codes together would result in improper reimbursement.
- Assistive technology assessment and device fitting: When a speech therapist provides an augmentative and alternative communication (AAC) device assessment (CPT code 92607) and an AAC device fitting and customization (CPT code 92609), these codes should not be billed together on the same day. The assessment should be billed separately from the fitting and customization service.
It’s important for speech therapists to stay informed about the latest CCI edits and coding guidelines to ensure accurate billing and prevent claim denials or overpayments. Regularly reviewing CCI edits and consulting with a certified medical coder can help ensure compliance with these rules.