EM Coding Alert

New E/M bundles concentrate on clinical immunology.

You’ll have to add a slew of new E/M-related Correct Coding Initiative (CCI) edits to your coding arsenal, thanks to version 20.1, implemented on April 1. Edits involving immunology and E/M services, and edits for observation services make up the bulk of the additions.  

“There are 4,322 new edit pairs, bringing the total active list to 1,314,537 active pairs,” says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. There are also 281 deleted pairs in this release.

Of the additions, Cohen adds that E/M codes topped the list at 70.89 percent and 22.42 percent of the terminated edit pairs. The good news is that we have scoured the list and will highlight what you need to know to avoid E/M denials. 

Unbundle 99211 When Needed

You’ll find that CCI 20.1 bundles 99211 (Office or other outpatient visit for the evaluation and management of an established patient …) with 36415 (Collection of venous blood by venipuncture). The modifier indicator for this bundle is “1,” meaning you can use a modifier to override the edit if the circumstance warrants the codes being billed separately.

E/M 99211 is also now bundled with:

• 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report)
• 93005 (... tracing only, without interpretation and report)
• 93010 (... interpretation and report only).

The modifier indicator for these three bundles is also “1.”

Review the Immunology Edits

CCI 20.1 take aim at clinical immunology procedures in the range 95004-95180 with most E/M codes, including:

• Office or other outpatient services codes 99201-99215
• Hospital observation services codes 99217-99226
• Hospital inpatient services codes 99231-99239
• Office or other outpatient consultation codes 
• 99241-99245 
• Initial inpatient consultation codes 99251-99255
• Emergency department services 99288 
• Critical care services codes 99291-99292
• Nursing facility services codes 99304-99318
• Domiciliary, rest home or custodial care services codes 99324-99337
• Domiciliary, rest Home or home care plan oversight codes 99339-99340 
• Home services codes 99341-99350
• Prolonged services code 99358
• Case management codes 99363-99368 
• Care plan oversight codes 99374-99380 
• Preventive medicine services codes 99381-99420 (99429 is not included)
• Non-face-to-face service codes 99441-99449 
• Basic life/disability exam code 99450
• Newborn care services codes 99460-99465
• Pediatric critical care transport code 99467
• Complex chronic care coordination  codes 99487-99488
• Transitional care codes 99495-99496.

These new bundles all carry a modifier indicator of “1.” See the chart on page XX for a complete list of which immunology codes bundle with which E/M codes. 

Take note: Code 95199 (Unlisted allergy/clinical immunologic service or procedure) is the only code in the allergy and clinical immunology procedures 95004-95180 range that wasn’t included in the edits. 

Don’t Miss 99172 and Observation Edits

You’ll also face new edits if your provider performs vision screenings, because CCI 20.1 now bundles many E/M codes with 99172 (Visual function screening…). Each of the following E/M codes bundles 99172 with a modifier indicator of “0”: 

• Office or other outpatient services codes 99201-99215
• Hospital observation services codes 99217-99226
• Hospital inpatient services codes 99231-99239 (99221-99226 are not included)
• Consultation services codes 99241-99255
• Emergency department services codes 99281-99288
• Critical care services codes 99291-99292
• Nursing facility services codes 99304-99318
• Domiciliary, rest home or custodial care services codes 99324-99337
• Domiciliary, Rest Home or home care plan oversight services codes 99339-99340
• Home services codes 99341-99350
• Prolonged services codes 99354-99360
• Case management services codes 99363-99368
• Care plan oversight services codes 99374-99380
• Preventive medicine services codes 99381-99420 (99429 is not included)
• Non-face-to-face services codes 99441-99449
• Special evaluation and management services codes 99450-99456
• Newborn care services codes 99460-99465
• Inpatient neonatal intensive care services and pediatric and neonatal critical care services codes 99466-99486
• Complex chronic care coordination evaluation and management services codes 99487-99489
• Transitional care evaluation and management services codes 99495-99496.

Brace Yourself For Bundles That Can’t Be Unbundled

Additionally, you’ll find 99235 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these three key components: a comprehensive history, a comprehensive examination, and medical decision making of moderate complexity…) now bundled with 99234 (... detailed or comprehensive history, a detailed or comprehensive examination, and medical decision making that is straightforward or of low complexity…). 

CCI also bundles 99234 and 99235 with 99236 (… a comprehensive history, a comprehensive examination, and medical decision making of high complexity…). All of these bundles have a modifier indicator of “0.”

CCI also adds the following bundles: 

• 99481 (Total body systemic hypothermia in a critically ill neonate per day…) pairs with 90832 (Psychotherapy, 30 minutes with patient and/or family member), 90834 (Psychotherapy, 45 minutes with patient and/or family member), and 90837 (Psychotherapy, 60 minutes with patient and/or family member)
• 99482 (Selective head hypothermia in a critically ill neonate per day…) bundles with 90832, 90834, and 90837
• 99486 (Supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, …) bundles 90837.

These edits all have a modifier indicator of “0,” which means you cannot unbundle the two codes under any circumstances.

Catch a Break With Limited Deletions

CPT® code 58823 (Drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous [such as ovarian, pericolic]) was deleted January 1, 2014. On the same day, six CCI pairs including 58823 and E/M services were deleted. The two affected E/M categories are:

• Non-face-to-face services codes 99446-99449
• Transitional care evaluation and management services codes 99495-99496.

Six months after CCI created 53 pairs of 58823 and E/M services, they deleted them on December 31, 2013.

Those deleted bundles involve the following E/M codes:

• Office or other outpatient services codes 99211-99115
• Hospital observation services codes 99217-99223
• Hospital inpatient services codes 99231-99239
• Consultation services codes 99241-99255
• Critical care services codes 99291-99292
• Nursing facility services codes 99304-99316
• Domiciliary, rest home or custodial care services codes 99334-99337
• Home services codes 99347-99350
• Care plan oversight services codes 99374-99378.

According to Melanie Witt, RN, CPC, MA, an independent ob-gyn coding expert based out of Guadalupita, N.M., CCI may have retroactively terminated these edits because “…they need to remove the bundles from their system and they get in the habit of just releasing when they make the changes without checking to see if the information still makes any sense. It is also why some years you will see an edit added and removed on the same date — it still shows up in the database.”

One more: Codes 99446-99449 (Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional …) are no longer bundled with G0275 (Renal angiography…).