Frequently Asked Questions

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FAQ

What's the difference between the Outpatient Code Editor (OCE) edits and the Correct Coding Initiative (CCI) edits?

The OCE edits and the CCI edits are two editing systems used to process fiscal intermediary and carrier-related claims, respectively. The CCI edits are developed based on coding conventions defined in the AMA's CPT Manual, current standards of medical and surgical coding practice, input from specialty societies, and based on analysis of current coding practice. CCI edits are used for carrier processing of physician services under the Medicare Physician Fee Schedule while the OCE edits are used by intermediaries for processing claims for all outpatient institutional providers including hospitals that are subject to the Outpatient Prospective Payment System (OPPS) as well as hospitals that are NOT (Non-OPPS). The OCE edits are not used within the Medicare Physician Fee Schedule. The CCI edits always consist of pairs of HCPCS codes, and are arranged in two tables. One is the column 1/column 2 correct coding edits table, and the other is known as the mutually exclusive edits table. The OCE edits are arranged in numerical order with descriptions for each edit, as well as a claim disposition for each edit. For further information on the latest OCE edits within the hospital OPPS, please visit our website at http://www.cms.hhs.gov/Manuals/ to find the latest transmittal (program memorandum) on the OCE.
(FAQ1909)

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