Claims Editor

The Claims Editor tool allows users to check codes against CCI edits, NCDs and LCDs, and MUEs in one location.

To begin, choose your location from the dropdown menu, then click whether you would like to view Practitioner or Hospital CCI edits and Non-Facility or Facility RVUs.

In each row below, you can enter:

• Date of service
• CPT/HCPCS code and units of service
• Modifiers
• Diagnosis (ICD-10-CM) codes

To add more than two procedures, click “Add another procedure” at the bottom. After entering all relevant codes, check the results in the right column. These may identify whether diagnosis codes will impact Risk Adjustment scores, if it may be appropriate to apply a modifier, and other advice. Comments in red indicate potential areas of concern, such as exceeding MUEs or medical necessity issues.

Watch: Claims Editor Tutorial