ED Coding and Reimbursement Alert

The edits, which took effect April 1, also tighten up vaccine coding

The latest version of the National Correct Coding Initiative has some ED edits you won't want to miss -- particularly when your ED physician performs debridement and treatment on the same burn site.

-Most of these edits seem to be trying to capture redundant codes and reduce redundant coding,- says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.

Burn and Debridement Bundles HIghlight This Quarter's NCCI

NCCI 13.1 outlaws reporting a pair of debridement codes with certain burn treatment codes in most situations, Moore says.

NCCI reports that the following codes are bundled into 16020 (Dressings and/or debridement of partial-thickness burns, initial or subsequent; small [less than 5 percent total body surface area]), 16025 (... medium [e.g., whole face or whole extremity, or 5 percent to 10 percent total body surface area]) and 16030 (... large [e.g., more than one extremity, or greater than 10 percent total body surface area]):

 - 11000 -- Debridement of extensive eczematous or infected skin; up to 10 percent of body surface

 - 11040 -- Debridement; skin, partial thickness.

Explanation: -The burn code descriptions include debridement, so you should not report both codes- when treatment occurs on the same wound, Moore says.

For example, a patient reports to the ED for treatment of a small partial-thickness burn on his arm. During the encounter, the physician performs debridement on the burn before treating it. In this instance, the debridement is bundled into the burn treatment. Report 16020 for the encounter.

All of these burn/debridement edits contain a modifier indicator of -1.- The -1- means you can report both of these codes for the same encounter in certain situations -- and with modifier 59 (Distinct procedural service) attached to the component (bundled) code.

Consider this scenario, in which you could rightfully unbundle these edits and report a debridement and burn treatment code:

A 25-year-old male reports to the ED four days after sustaining grease burns while working as a cook. The left arm has a small second-degree burn, which the physician debrides and then treats with topical silvadene. The right arm has several large areas of infected necrotic skin from old injuries, likely resulting from several untreated lacerations. The physician debrides the infected skin on the right arm and places the patient on oral antibiotics.

In this scenario, you can report the debridement and the burn treatment because the procedures occurred on different body areas, says Michael Granovsky, MD, CPC, FACEP, vice president of MRSI, an ED coding and billing company in Woburn, Mass.

On the claim, 

 - report 16020 for the treatment of the left arm burn.

 - report 11000 for the debridement of the infected skin on the right arm.

 - attach modifier 59 to 11000 to show that the burn treatment and debridement were separate services.

For Push/Injection Combo, Only Report Push

ED coders should also note an NCCI edit they-ll need to observe when the physician performs an intravenous push and an injection in the same session. NCCI 13.1 announces that 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) is bundled into 90774 (... intravenous push, single or initial substance/drug).

Explanation: During these encounters, -the insurer will pay for the push but not the injection,- Moore says.

Consider this example from Granovsky: A 72-year-old female presents with chronic pain from multiple myeloma. She is a difficult IV stick. The physician orders 1 mg of SQ Dilaudid while the IV is being started. After a few difficult sticks, an IV is started and the patient receives an additional 1 mg of Dilaudid IV.

 -The SQ injection on its own would be reported with 90772; however, the patient also received an IV push of Dilaudid, which is reported with 90774,- Granovsky says. In this instance, you would report only 90774 for the service.

NCCI Tightens Up Vaccination Code Group

There are also several new bundles in the vaccine code family, Moore says. Code 90714 (Tetanus and diphtheria toxoids [Td] adsorbed, preservative free, when administered to 7 years or older, for intramuscular use) is bundled into 90698 (Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated [DTaP-Hib-IPV], for intramuscular use) with a modifier indicator of -1.-
 Here are the other vaccine edits of note:

 The following codes are bundled into 90714:

- 90700 -- Diphtheria, tetanus toxoids, and acellular pertussis vaccine -

- 90701 -- Diphtheria, tetanus toxoids, and whole cell pertussis vaccine -

- 90702 -- Diphtheria and tetanus toxoids adsorbed -

- 90703 -- Tetanus toxoid adsorbed -

- 90718 -- Tetanus and diphtheria toxoids (Td) adsorbed ...

- 90719 -- Diphtheria toxoid -

 All of these edits contain a -1- modifier indicator with the exception of 90703 and 90718, which have modifier indicators of -0.- 
 
 The following codes are bundled into 90715
(Tetanus, diphtheria toxoids and acellular pertussis vaccine [TDap], when administered to 7 years or older, for intramuscular use):
 
- 90698

 - 90700

 - 90701

 - 90702

 - 90703

 - 90714

 - 90718

 - 90719.

 All of these edits contain a -1- modifier indicator.
 
The following codes are bundled into 90720
(Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Hemophilus influenza B vaccine [DTP-Hib], for intramuscular use) and 90721 (Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine [DTaP-Hib], for intramuscular use):
 
- 90714

- 90715.

 Both of these edits contain a -1- modifier indicator.