Gastroenterology Coding Alert

If the news about the huge set of new Correct Coding Initiative (CCI) edits for this quarter has your head spinning, don't worry. You'll only have a few edit pairs to worry about in your gastroenterology practice.

Let our experts help you narrow your focus. Version 15.1, effective April 1, contains 304,038 additions. This has increased the total present-day CCI database to 629,107 edit pairs.

Despite the numerous edits, CCI aims its fire at a select few codes this round, with only 524 unique codes listed in column 2 of the new column 1/column 2 edit list. "Only 48 codes make up the top 80 percent" of those listed, said Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla., in a March 12 news release.

"In most cases, procedures such as injections performed during surgery would be included in the main surgical procedure anyway, so these edits shouldn't hurt too badly," says Heather Corcoran with CGH Billing in Louisville, Ky.

One thing to watch out for: 43752 (Naso- or orogastric tube placement, requiring physician's skill and fluoroscopic guidance [includes fluoroscopy, image documentation and report]) is bundled into numerous codes. That probably won't come up too often during a 43234 (Upper gastrointestinal endoscopy, simple primary examination [e.g., with small diameter flexible endoscope] [separate procedure]) but it's bundled just the same.

Additionally: New edits bundle nerve block and injection codes (623xx and 644xx) into almost every surgical procedure code in the 2009 CPT manual. You'll also face numerous new bundles listing almost every code in the integumentary section of the CPT manual, wound exploration and biopsy codes in the musculoskeletal section (20000-20251), and almost every surgical procedure in column 1. The column 2 codes with a modifier indicator of 1 (indicating you may override the edit with a modifier when appropriate) include:

• Venipuncture: 36400-36406, 36420-36425

• Transfusion: 36430

• Push transfusion: 36440

• Arterial puncture/catheterization: 36600, 36640

• Naso- or oro-gastric tube placement: 43752

• Anesthetic agent injection: 64505-64530

• Surface neurostimulator application: 64550

• ECG: 93000-93010, 93040-93042

• Transesophageal echocardiography: 93318

• Pulmonary services: 94002, 94200, 94250, 94680 94690, 94770

• Electroencephalography: 95812-95822, 95829, 95955

• Sequential IV push: +96376.

Column 2 codes with a modifier indicator of 0 (indicating you may never override the edit) include: epidural or subarachnoid injection: 62310-62311 and anesthetic agent injection: 64400-64413, 64418-64449,64479, 64483.