NCCI Update:
Version 9.1 Bundles Ultrasound Guidance
Published on Thu May 01, 2003
It's official: The latest National Correct Coding Initiative edits bundle ultrasound-guided fine needle aspirations into other endoscopies. Gastroenterology coders should also look out for edits bundling hemorrhoidectomies and anesthesia procedures. NCCI Bundles 76942 Into 43231 It may seem common sense to you, but NCCI wants to make absolutely sure you don't code separately for ultrasonic guidance with some of your most common endoscopies. The edits bundle 76986 (Ultrasonic guidance, intraoperative) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) into several common endoscopies. According to Linda Parks, MA, CPC, CCP, coding specialist at GI Diagnostics Endoscopy Center in Marietta, Ga., you have never been able to code ultrasound guidance for 43232 (Esophagoscopy, rigid or flexible; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s]), 43242 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy[s]), and 45341 (Sigmoidoscopy, flexible; with endoscopic ultrasound examination), and you still cannot.
NCCI now bundles 76942 into 43231 (Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination) and 43259 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination), but you can unbundle these with modifier -59 (Distinct procedural service), Parks says.
NCCI also bundles ultrasonically guided fine needle aspiration and ultrasound examination codes into several endoscopies in the same families: Code 43239 (EGD; with biopsy, single or multiple) is now bundled into codes 43242 and 43259. You can unbundle this with modifier -59 if it is appropriate. Code 43202 (Esophagoscopy, rigid or flexible; with biopsy, single or multiple) is now bundled into code 43232, but again, it may be unbundled with modifier -59. Code 45331 (Sigmoidoscopy, flexible; with biopsy, single or multiple) is bundled into code 45342 (... with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy[s]), but may also be unbundled with modifier -59. NCCI Adds to Hemorrhoidectomy Bundles You cannot report 46221 (Hemorrhoidectomy, by simple ligature [e.g., rubber band]) separately from the following hemorrhoid codes:
46230 Excision of external hemorrhoid tags and/or multiple papillae
46250 Hemorrhoidectomy, external, complete
46255 Hemorrhoidectomy, internal and external, simple; 46257 ... with fissurectomy; and 46258 ... with fistulectomy, with or without fissurectomy. These hemorrhoidectomy bundles will not affect coding substantially, Parks says. In current practice, physicians treat a hemorrhoid either by rubber-band technique (46221), which allows it to die off, or by removing the hemorrhoid (46230-46258) not both. Watch Out for Anesthesia and Miscellaneous Edits 43259 includes 93041 (Rhythm ECG, one to three leads; tracing only without interpretation and report)
43242 and 43259 include 93976 (Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents [...]
