I work in a comprehensive outpatient rehabilitation facility (CORF). Do I have to follow the CCI edits and do they apply to the therapy services I provide?
The Correct Coding Initiative (CCI) edits were established in 1995 in an effort to reduce the number of unbundled services, standardize claims coding and payment on a national level, and to cut down on abusive coding practices with Medicare claims by identifying inappropriate CPT code combinations. During this time, physicians, occupational therapists in private practice, and outpatient hospitals were required to follow the CCI edits. On January 1, 2006, occupational therapists who work in CORFs, skilled nursing facilities (SNFs), rehabilitation agencies, home health agencies (HHAs) in addition to the settings prior to this time, were required to follow CCI rules. Today, many other payers besides Medicare follow the guidelines of the CCI edits and require them for proper payment of services. Always check with your payer to see if CCI edits are being implemented. For additional information on CCI, visit the AOTA Reimbursement section at www.aota.org or the CMS Web site at http://www.cms
