ED Coding and Reimbursement Alert

These new and existing codes can't be reported with the code for manual therapy techniques

ED coders don't have a lot to contend with in the latest round of NCCI edits, effective April 1, but if you're reporting the application of multi-layer compression systems to extremities, you'll want to note some important changes.

The stats: Version 18.1, which incorporates all previous versions and updates from Jan. 1, 1996, to the present, contains 362 added codes, all of which are non-mutually exclusive. There are also six deleted codes, of which two are mutually exclusive and four are non-mutually exclusive. Almost all of the new edits relate to surgical procedures not typically performed in the ED.

(See Summary of Added and Deleted CCI Code Pairs for April 2012 on page 34 for a summary of codes sets included in Version 18.1)

All three of the application of multi-layer compression systems codes below are now non-mutually exclusive pairs with 97140 (Manual therapy techniques [e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction], 1 or more regions, each 15 minutes):

• 29582 (Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed)
• 29583 (Application of multi-layer compression system; upper arm and forearm)
• 29584 (Application of multi-layer compression system; upper arm, forearm, hand, and fingers)

Whereas the application of compression system codes are occasionally performed in the ED, the manual therapy code is not. Review your group's use of these code pairs to see if you need to revise your reporting policy, says Todd Thomas, CPC, CCS-P, President of ERcoder, Inc. in Edmond, OK.

Look for Streamlined Edit Groupings

There's a twist in the way this latest round of edits is organized that could make things easier for you.

That was then: Since 1996, the Medicare NCCI procedure to procedure edits have been assigned to either the Column One/Column Two Correct Coding edit file or the Mutually Exclusive edit file based on the criterion for each edit, says Thomas. The Mutually Exclusive edit file included edits where two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations. All other edits were assigned to the Column One/Column Two Correct Coding edit file.

New look: Starting in April 2012, CMS is consolidating the two edit files into the Column One/Column Two Correct Coding edit file. Separate consolidations will occur for the two practitioner NCCI edit files and the two NCCI edit files used for Outpatient Code Editor (OCE). Thomas explains that with this change, you'll only need to search the Column One/Column Two Correct Coding edit file for active or previously deleted edits.

MUEs relocate: And effective April 1, 2012, he continues, CMS will no longer publish a Mutually Exclusive edit file on its website for either practitioner or outpatient hospital services, since all active and deleted edits will appear in the single Column One/Column Two Correct Coding edit file on each website. Be sure to remember that the edits previously contained in the Mutually Exclusive edit file are not being deleted but are being moved to the Column One/Column Two Correct Coding edit file, adds Thomas.