Correct Coding Initiative (CCI) Edits - Empire Blue Cross Blue Shield

* As of 3/10/06Correct Coding Initiative (CCI) EditsSpring 2006Empire is increasing its compliance with industry standards by adopting the following code combinations from theCenter for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (CCI) into our payment policy.The National Correct Coding Initiative is a collection of bundling edits that are separated into two major categories:Comprehensive/Component Procedure Code edits and Mutually Exclusive Procedure Code edits.Comprehensive/Component Procedure Code editsCodes that are considered "Components" are incidental to the codes considered to be "Comprehensive" and will bedenied as such. The table below lists the procedure that will be denied—"Deny Procedure"—as incidental to thecorresponding "When Billed with Procedure."Mutually Exclusive Procedure Code editsMutually Exclusive Procedures are procedures that cannot be reasonably done in the same session.To be consistent with existing payment policy, when Mutually Exclusive procedures are billed for the same date ofservice, only the procedure with the highest relative value ("When Billed with Procedure") will be allowed and theprocedure with the lower relative value ("Deny Procedure") will be denied as Mutually Exclusive of the otherprocedure.In some situations, according to CMS, certain modifiers may be allowed to bypass these edits.Deny Procedure When Billed With Procedure Modifier Exception Apply00400 95955 N00740 43239 N00810 45385 N01400 95955 N01630 95955 N01996 1968 Y13131 26418 Y13132 26418 Y19318 19367 Y19361 19357 Y21320 21337 Y29823 23410 Y29826 23410 Y35381 35566 Y35456 35556 Y36215 36216 Y36216 36217 Y38220 38221 Y38221 20220 Y44200 43843 Y44200 44204 NServices provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.1 of 21

Correct Coding Initiative (CCI) EditsSpring 200645378 45384 N45378 45385 N45380 45385 Y45384 45380 Y49560 44200 N53661 53660 Y61312 61697 Y63012 22630 Y63047 22630 Y63075 63081 Y64718 25020 Y64722 63047 Y71551 71552 Y74182 74183 Y76375 70549 N76375 77290 N76375 70498 N76375 71275 N76375 71555 N76375 72191 N76375 74175 N76375 77295 N76375 77295 N76375 70544 N76375 70547 N76375 73725 N76375 74185 N76828 76375 Y76942 76095 Y80076 80053 N81002 81000 N83090 82139 Y83715 83721 N83718 80061 N83718 83715 N83718 83716 N83719 83716 N83721 83716 N83890 87490 Y83890 87490 Y83890 87491 Y83890 87520 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.2 of 21

Correct Coding Initiative (CCI) EditsSpring 200611040 11057 Y11041 13131 Y11041 11042 Y11041 10060 Y11041 13132 Y11041 12002 Y11042 10060 Y11042 15574 Y11042 11043 Y11042 15400 Y11042 14021 Y11043 13131 Y11044 13132 Y11044 13152 Y11055 10160 Y11055 11040 Y11055 17000 Y11055 11721 Y11055 17110 Y11056 11041 Y11056 17000 Y11056 17110 Y11057 10140 Y11057 11308 Y11057 11306 Y11100 17004 Y11100 17262 Y11100 17111 Y11100 11312 Y11100 11400 Y11200 11403 Y11200 11306 Y11300 11100 Y11301 11100 Y11305 17250 Y11305 11057 Y11305 17000 Y11400 12031 Y11401 19120 Y11401 10061 Y11426 14021 Y11622 14060 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.5 of 21

Correct Coding Initiative (CCI) EditsSpring 200611719 11720 Y11720 11043 Y11720 11721 N11720 11040 Y11720 11055 Y11720 11056 Y11720 11057 Y11721 29580 Y11721 99347 Y11721 11040 Y11721 11000 Y11721 10060 Y11721 11730 Y11721 10140 Y11721 11042 Y11721 10160 Y11721 11750 Y11721 10061 Y11721 11041 Y11721 11056 Y11721 11057 Y11730 10060 Y11740 10061 Y11750 11752 Y11750 10061 Y11760 13131 Y11760 13132 Y11900 17004 Y11900 11901 N11900 17000 Y11900 17110 Y11901 17000 Y11901 96405 Y12001 11441 Y12001 11640 Y12001 12011 Y12031 11462 Y12031 12041 Y13121 25260 Y13131 20103 Y13132 14040 Y17000 17004 N* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.6 of 21

Correct Coding Initiative (CCI) EditsSpring 200617000 11042 Y17000 11100 Y17000 11057 Y17000 11403 Y17000 11421 Y17000 11401 Y17000 11312 Y17000 11301 Y17000 11302 Y17000 11602 Y17000 11443 Y17000 11441 Y17000 11306 Y17000 17282 Y17000 11311 Y17000 11442 Y17000 11307 Y17000 11402 Y17000 11440 Y17000 11310 Y17000 69100 Y17004 17106 Y17110 11400 Y17250 11750 Y17250 11730 Y17280 11641 Y19100 10022 Y19100 76942 Y19160 19162 Y19295 19290 Y20550 64450 Y20550 20610 Y20550 64445 Y20550 29125 Y20551 64475 Y20551 26500 Y20552 20553 N20552 20605 Y20552 64445 Y20552 20610 Y20553 64400 Y20553 64475 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.7 of 21

Correct Coding Initiative (CCI) EditsSpring 200620553 20610 Y20600 20550 Y20600 29125 Y20600 64450 Y20605 20526 Y20605 10061 Y20605 20550 Y20605 64475 Y20605 64450 Y20610 62311 Y20610 29881 Y20610 27093 Y20612 10061 Y20650 28296 Y20680 27472 Y20680 27244 Y20900 27822 Y21556 21555 Y23620 23600 Y24147 24149 Y25111 25332 Y27030 27244 Y27340 27447 Y28002 28124 Y28002 28120 Y28108 28296 Y28285 28292 Y28285 28296 Y28288 28296 Y28290 28289 Y29075 25600 Y29075 26645 Y29125 25600 Y29130 26770 Y29260 20605 Y29345 28740 Y29405 28470 Y29425 27786 Y29515 27792 Y29530 20610 Y29540 20552 Y29540 28510 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.8 of 21

Correct Coding Initiative (CCI) EditsSpring 200629540 64450 Y29540 20600 Y29540 20550 Y29540 20605 Y29540 11040 Y29540 11750 Y29540 29580 Y29550 20600 Y29580 20605 Y29580 64450 Y29580 11041 Y29580 20600 Y29580 11042 Y29580 20550 Y29705 27750 Y29826 23412 Y29879 27455 Y29881 27455 Y30115 31201 Y31231 31238 N31237 31267 Y31256 31267 Y31505 43200 N31575 31231 Y31575 92511 Y31622 32100 Y31625 31628 Y33225 75860 N35226 33427 Y35903 35236 Y36000 90765 Y36000 93015 Y36000 74415 Y36000 73223 Y36000 36600 Y36215 36217 Y36245 93510 Y36245 36247 Y36405 99295 Y36406 99295 Y36406 36000 Y36410 78709 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.9 of 21

Correct Coding Initiative (CCI) EditsSpring 200636410 94060 Y36410 93015 Y36410 76076 Y36410 31505 Y36410 51741 Y36410 17110 Y36410 69210 Y36410 70552 Y36410 71260 Y36410 72158 Y36410 72193 Y36410 74170 Y36410 74415 Y36410 78215 Y36410 78306 Y36410 92235 Y36410 43239 Y36410 95922 Y36410 36000 Y36410 36420 N36620 99296 Y36660 99295 Y37202 27654 Y37202 23412 Y37202 29826 Y38100 44005 N38500 49505 Y39220 32484 Y42826 42145 N43200 43202 N43200 43750 Y43234 43239 N43235 43239 N43251 43239 Y43259 43235 N43752 74340 N43800 43840 Y43820 44005 N44005 44120 N44005 50820 N44005 47120 N44050 44005 N* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.10 of 21

Correct Coding Initiative (CCI) EditsSpring 200644120 44160 Y44360 43239 N44360 43259 N44388 44394 N44950 44900 N44950 38562 N44970 44960 Y45300 46600 N45378 45380 N45384 45385 Y45385 45383 Y46275 46040 N46600 46946 Y46600 46221 Y46600 46934 Y46600 46942 Y46600 45330 N46600 46500 Y49000 44151 N49000 59510 N49000 43632 N49000 43840 N49000 44005 N49000 44320 N49000 44602 N49000 38100 N49010 58150 N49081 49080 Y49255 49561 N49255 44140 N49424 58823 Y49570 49585 N51600 52281 Y51700 51703 N51701 76775 Y51701 52000 N51701 76770 Y51702 51720 N51702 52000 N51720 52224 Y51795 51702 N51798 76856 N* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.11 of 21

Correct Coding Initiative (CCI) EditsSpring 200651798 76857 N51798 76770 Y51798 76872 Y52000 52235 N52000 55859 N52000 52332 N52005 50220 Y52005 52345 N52005 52332 N52005 52352 N52005 52353 N52235 52354 Y52235 52332 Y52276 52400 N52332 52353 Y52332 52352 Y52341 52353 Y53660 52000 N54050 54056 Y54640 54512 Y57135 57106 Y57150 57160 Y57250 57240 N57410 49320 Y57410 59820 N57410 58558 N57420 57510 N57420 57454 N57452 57455 N57452 57420 N57452 57106 N57452 57510 N57452 58120 N57500 57510 N57500 57454 N57500 57460 N57505 57420 N57505 57454 N57505 57421 N57800 58100 N58100 56515 N58100 57500 N* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.12 of 21

Correct Coding Initiative (CCI) EditsSpring 200658120 58353 N58661 58660 N58740 58150 N58920 44005 N59020 76819 Y59025 76815 Y59025 76819 Y59025 76818 Y59200 59400 N60001 10022 Y62311 64483 Y63047 63042 Y64550 90911 Y64550 20550 Y64718 24149 Y64721 25115 Y65400 65426 Y66852 67036 Y67343 67318 Y67515 66984 Y68801 68810 Y68840 68440 Y69210 92587 N69210 92588 N69210 69610 Y69210 92585 N69210 92557 N70300 70355 N70450 70460 N70450 70480 Y71010 36556 Y71010 74022 Y71010 71020 Y71010 71100 Y71010 99291 Y71020 36556 Y71020 71101 Y71020 71030 Y71020 71111 Y71100 71101 N72020 72052 Y72020 72110 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.13 of 21

Correct Coding Initiative (CCI) EditsSpring 200672040 72010 Y72040 72052 Y72100 72010 Y72120 72110 N72170 73520 Y72275 62319 Y72275 62311 Y72275 64483 Y72275 62310 Y73020 73030 Y73100 73110 Y73120 73130 Y73140 73130 Y73140 73120 Y73500 73510 Y73560 73562 Y73565 73562 Y73565 73564 N73600 73610 Y73620 73630 Y73660 73620 Y74000 74020 Y74000 74450 Y74010 74020 Y74210 74247 Y74220 74241 N74220 74247 N74220 74245 N74320 75980 N74410 74420 Y74425 50688 Y74430 74420 N74430 76000 Y75625 75722 Y75630 93510 Y75630 93526 Y75710 75962 Y75710 75960 Y75710 35226 Y75710 93510 Y75710 93526 Y75710 75630 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.14 of 21

Correct Coding Initiative (CCI) EditsSpring 200675716 75960 Y75716 75630 Y75724 93510 Y75724 93526 Y75790 75827 Y75820 75658 Y75825 75940 Y75825 76942 Y75827 75978 Y75989 76360 Y76000 52005 Y76000 74420 Y76001 62287 Y76003 36558 Y76003 75630 Y76003 76360 Y76005 72275 Y76066 76000 Y76090 76091 N76096 76942 Y76393 76942 Y76536 93880 Y76700 93975 Y76700 93976 Y76705 93975 Y76705 76700 Y76770 93975 Y76770 93976 Y76770 93978 Y76775 93975 Y76775 93976 Y76775 93978 Y76805 76816 N76805 76831 N76805 76830 N76815 76830 N76816 76810 Y76816 76830 N76826 76825 Y76830 76801 N76830 76811 N76830 76831 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.15 of 21

Correct Coding Initiative (CCI) EditsSpring 200676856 93975 Y76856 93976 Y76857 51702 Y76857 76856 Y76857 93980 Y76872 53852 Y76872 53850 Y76880 93970 Y76880 93971 Y76880 93930 Y76880 93965 Y76937 93971 Y76937 76942 Y76942 36558 Y76942 49021 Y76942 43259 Y76942 75894 Y76942 36569 Y76942 19101 Y76942 75790 Y76942 75989 Y76950 77301 N76950 77301 N76975 43259 N77261 77336 Y77263 77301 N77280 77295 N77290 77295 N77305 77321 Y77310 76370 N77310 76370 N77315 77295 N77315 77321 Y77331 77300 N77331 77300 N77334 77301 Y77336 77334 Y77336 77310 Y77336 77263 Y77432 77470 N77470 77301 N77470 77418 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.16 of 21

Correct Coding Initiative (CCI) EditsSpring 200677778 77784 Y77778 77784 Y78010 78006 N78220 78223 Y78472 78465 N78472 78483 N78473 78465 N78700 78710 Y78730 76770 N78805 78807 Y88104 88108 Y88104 88173 Y88108 88173 Y88160 88173 Y88162 88173 Y88172 88104 Y88172 88162 Y88342 88360 Y90760 90765 Y90760 43239 Y90765 93015 Y90765 78465 Y90774 93015 Y90774 78465 Y92002 99203 N92012 92014 N92020 65855 Y92135 92250 Y92140 92120 Y92250 92240 Y92285 92020 Y92504 69210 N92511 31231 N92520 31579 Y92553 92557 N92555 92557 N92556 92553 N92563 92553 N92567 69210 N92568 69210 N92582 69210 N92981 92980 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.17 of 21

Correct Coding Initiative (CCI) EditsSpring 200692981 92982 N92984 92980 Y92984 92981 Y93000 93731 Y93000 93741 Y93000 93015 Y93000 93732 Y93000 93734 Y93000 93735 Y93000 93743 Y93000 95921 Y93000 93733 Y93000 93736 Y93005 93000 Y93010 93015 Y93010 93613 Y93010 93735 Y93010 93278 Y93010 93018 Y93010 93000 Y93010 93612 Y93016 93015 N93018 93015 N93040 64483 Y93040 62311 Y93040 64484 Y93040 93015 Y93040 93307 Y93040 93000 Y93040 93320 Y93040 64520 Y93040 93230 Y93041 95922 Y93041 93000 Y93042 93010 Y93224 93268 Y93227 93224 N93231 93230 N93231 93236 Y93231 93224 Y93270 93268 N93270 93236 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.18 of 21

Correct Coding Initiative (CCI) EditsSpring 200693272 93268 N93278 95921 Y93307 93304 Y93307 93350 Y93307 93303 N93307 93308 Y93308 93350 Y93314 93312 N93508 93510 N93555 35226 Y93556 35226 Y93620 93641 Y93624 93651 Y93720 94360 Y93727 93270 Y93735 93724 Y93742 93743 Y93743 92960 Y93922 93924 Y93978 93976 N94010 94060 N94010 94375 N94010 95070 Y94016 94375 Y94060 94620 Y94200 94060 Y94200 94620 Y94200 94010 Y94200 94621 Y94260 93720 Y94375 94060 N94640 94070 Y94640 94664 Y94657 99291 N94664 94060 Y94760 94620 N94760 93015 N94760 45380 N94760 99291 N94760 94761 N94761 45385 N94761 45378 N* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.19 of 21

Correct Coding Initiative (CCI) EditsSpring 200694761 93015 N95146 95149 Y95810 95811 N95816 95953 Y95819 95954 N95819 95953 N95831 99214 N95831 99242 N95831 99244 N95831 99245 N95833 99242 N95834 99244 N95851 99213 N95851 97750 N95851 97140 Y95851 99244 N95851 99243 N95851 99245 N95852 99244 N95860 64614 N95867 64612 N95868 64612 N95868 64640 N95869 95861 Y95900 95903 Y95920 60500 Y95920 95864 Y95927 60500 Y96409 96413 Y97001 64470 Y97124 64483 Y97124 64484 Y97140 64445 Y98926 64475 Y99217 99219 N99217 99220 N99232 99238 N99238 99222 N99238 99223 N99243 92004 N99254 99296 NG0009 90471 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.20 of 21

Correct Coding Initiative (CCI) EditsSpring 2006G0246 99215 NJ1642 78465 Y* As of 3/10/06Services provided by Empire HealthChoice HMO, Inc., and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association ofBlue Cross and Blue Shield Plans.21 of 21