ED Coding and Reimbursement Alert

If you missed CMS Transmittal 1136 released Nov. 1, 2012, you’re behind the curve on a crucial modifier update that could affect your claims.

Unlike previous transmittals that include lists of hundreds of new or deleted coding pairs, this quarterly update adds four new modifiers.

Previously, NCCI-associated modifiers are: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, RC, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, 25, 27, 58, 59, 78, 79, and 91.

What’s new: Additional modifiers have been added to the above list of NCCI-associated modifiers that will allow an edit with modifier indicator of "1" to be bypassed when the modifier is utilized correctly. These modifiers are as follows:

• LM (Left main coronary artery);
• RI (Ramus intermedius coronary artery);
• 24 (Unrelated evaluation and management service by the same physician during a postoperative period); and
• 57 (Decision for surgery).

Big change: These edit modifier lists don’t change in a meaningful way very often. Although the coronary artery modifiers are not so relevant to emergency medicine, the addition of the 24 and 57 to acceptable status indicator 1 edits is a big coding change, says Michael A. Granovsky, MD, FACEP, CPC, President of LogixHealth, an ED coding and billing company in Bedford, MA.

Stay tuned: Medicare Claims Processing Manual, Pub. 100.04, Chapter 23, Section 20.9.1 and 20.9.1.1 will be updated in the near future to include these new NCCI associated modifiers.