ED Coding and Reimbursement Alert

You need to know these edits if you report 20527 or 29582

New codes aren't the only things that affect your ED coding in 2012 "Correct Coding Initiative (CCI) edits version 18.0 went into effect Jan. 1, 2012, with 15,530 new edit pairs, says Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, a medical coding and billing company in Bedford, MA.

Although few of the new edits are focused on frequently used emergency medicine services, you should review the list for bundled code pairs if you report 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed) or 20527 (Injection, enzyme [e.g., collagenase], palmar fascial cord [i.e., Dupuytren's contracture]). These two CPT^® codes are now paired with hundreds of codes from the surgical section; especially those related to trigger point injections, fracture and dislocation services.

Trigger Point InjectionsAre Targets

If your ED group administers trigger point, joint, or tendon injections, don't miss the CCI edits involving those procedures:

Reminder: When CCI edits pair two codes together, you'll typically report the Column 1 code instead of the Column 2 code. The Column 1 code either represents a procedure that includes the services of the Column 2 code, or represents a procedure that "outweighs" the Column 2 code and should be reported alone.

Note This Crucial Timing Change

CMS Transmittal 2370, effective Dec. 16, 2011 outlines Integrated Outpatient Code Editor (I/OCE) instructions and specifications for the I/OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, including the ED.

The I/OCE routes all institutional outpatient claims (which includes non-OPPS hospital claims) through a single integrated OCE which eliminates the need to update, install, and maintain two separate OCE software packages on a quarterly basis.

Facility coders, take notice: In the past, the CCI edits have been one quarter behind. Effective for Jan. 1, 2012, the current quarter (Version 18.0) of the CCI edits will be implemented. Facility coders in particular should be aware that there is no longer a one quarter lag between the CCI edits and integration into the OCE logic. This will create greater consistency but may require updating your systems more quickly with each new publication of the CCI edits, says Granovsky.

Resource: Visit the CMS website https://www.cms.gov/MLNMattersArticles/downloads/MM7616.pdf for a complete look at Version 18.0 CCI edit changes.