EM Coding Alert

Take advantage of the bundles with a ‘1’ modifier indicator and get paid for more.

While it may be no surprise to you that the latest Correct Coding Initiative (CCI) edits version 20.3 impacts E/M service codes, the good news is there are no broad changes. The majority of the E/M codes bundle with new radiology, urology, and psychiatric codes and you can override most of them. 

“There are 5,247 new edit pairs, bringing the total number of active edits to 1,340,201,” says Frank Cohen, MPA, MBB, principal and senior analyst for The Frank Cohen Group in Clearwater, Fla. In his analysis, Cohen notes that 50 percent of the column 1 codes involved in the new CCI bundles are E/M codes.

There’s no need for you to go through all of the 5,247 pairs looking for E/M codes. We’ve taken care of that for you, so read on to focus in on what you need to learn.

Pair E/M with Beneficial Radiology Tools 

CCI 20.3 focuses its sights on several new Category III CPT® codes that took effect on July 1, 2014. 

You won’t be able to report most E/M services your provider performs at the same time as two radiology services: 0347T (Placement of interstitial device[s] in bone for radiostereometric analysis [RSA]) and 0356T (Insertion of drug-eluting implant [including punctual dilation and implant removal when performed] into lacrimal canaliculus, each). See the table on page 91 to review which E/M codes CCI bundles with these codes. 

These new bundles mean you should not report 0347T or 0356T and an E/M service together for the same patient on the same calendar date of service. 

Many of the other 0347T/0356T and E/M bundles, however, carry a modifier indicator of “1,” meaning you can unbundle the codes if you use an appropriate modifier and your physician’s documentation clearly supports the separate visit. The modifier that you will have to attach to the code in column 2 (which in this case is the E/M code) is 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service). 

Knowing how these new bundles will impact your practice may depend on the payer you are billing and their coverage determination for the codes. If the payer pays for these radiology services, you will most likely need modifier 25 on the visit codes and the documentation would need to support both the visit and the procedure being done, says Suzan Berman (Hauptman), MPM, CPC, CEMC, CEDC, director of coding operations-HIM at Allegheny Health Network in Pittsburgh, Pa. 

Beware: When 0347T is paired with 99446-99449 and 0356T is paired with 99446-99449, 99495, or 99496, there’s a modifier indicator of “0,” meaning you cannot unbundle the two codes under any circumstances. Therefore, you will not use modifier 25 on the non-face-to-face codes. “For the 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; …) services, these are phone calls that would not make sense billed with a procedure, thus they would not be billable in addition to the procedures,” Berman explains.

Introduce Yourself to the New Psychiatric Bundles

You’ll also find  16 new Category III psychiatric service codes that took effect on July 1, 2014 (0359T-0374T) bundled with all of the E/M codes with the exception of 99499 (Unlisted evaluation and management service). These bundles have a “1” modifier indicator, meaning you can use a modifier to override the edit if the circumstance warrants separately coding.

If you try to report an E/M service with one of the 16 psychiatric service codes without a modifier, your payer will only pay for the E/M service.

See the table on page 91 to review CCI E/M and psychiatric bundles. 

Review New Urology Bundles 

CCI 20.3 also targets two 2014 HCPCS urology codes — C9739 (Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants) and C9740 (...  4 or more implants) — bundling them with most E/M codes you might use. Review the table on page 91 for more details on these bundles. 

Most of these edit pairs have a modifier indicator of “1,” meaning you can unbundle and bill both the services if you use an appropriate modifier. Without a modifier, the payer will only pay the urology codes. Eight of the bundles (those between E/M codes 99446-99449 and C9739 and C9740) can’t code separately under any circumstance because they have an indicator of “0.” 

As with all other surgical procedures, the bundling of these two codes with E/M clarifies that if the “E/M like” tasks performed are the tasks typically performed with the planned procedure, that doesn’t mean that a separate E/M is performed, says Joan Gilhooly, MBA, CPC, CPCO, president and consultant for Medical Business Resources, LLC in Lebanon, Ohio.