CCI Validator

The CCI Validator can be accessed from the home page, the right column of any code detail page, or the Bill Pad.

First, choose whether to apply Hospital or Practitioner CCI edits. Next, choose whether to view Facility or Non-Facility RVUs. Then enter the CPT and HCPCS codes into the box and click Validate. The edits for the latest quarter will be loaded. Expert and Payer users may use the Date of Service tool to select a previous date and automatically view the edits from that year and quarter when using the CCI Validator.

The results will be ordered by total RVU with each code positioned as the Column 1 code. High- and moderate-risk codes include Denial Risk Monitor alert icons, directly sourced from CMS reimbursement data. Beneath each Column 1 code, you will find ICD-10-CM and HCPCS crosslinks. Anesthesia crosslinks are available for subscribers with the ASA Crosslinks add-on and CPT Assistant articles are available for subscribers to the CPT Assistant add-on.

Each code pair will show whether there are no bundling edits (green checkmark), a potential conflict that may require an appropriate modifier (yellow exclamation point), or an edit that will only allow one of the codes in the pair to be reimbursed (red X). Red text may highlight additional CMS instruction or guidance, while green text will highlight code pairs with no bundling edits.

When applicable, you’ll now see CMS' Procedure-to-Procedure (PTP) edit rationale following the validated codes—for example, “More extensive procedure."

Watch: How to Use the CCI Validator