General Surgery Coding Alert

General surgeons and their coders will want to pay close attention to Correct Coding Manual Version 7.3 (CCM 7.3), the latest version of the manual that compiles all changes to the Correct Coding Initiative (CCI), as it contains significant revisions to long-standing coding conventions. "A lot of this is just plain common sense coding, but now it has been put in writing, which will be really helpful with carriers and surgeons," says Elaine Elliott, CPC, a coding and reimbursement specialist in Jensen Beach, Fla.
Modifiers
Modifier -22. CCI now states: "When an unusual or extensive service is provided, it is more appropriate to utilize the -22 modifier than to report a separate code that does not accurately describe the procedure performed." The guidelines note that routine use of the modifier is inappropriate, because this modifier is meant for unusual circumstances only. Chapter One/Section C9 of the CCI now instructs surgeons to use modifier -22 (unusual procedural services) if a laparoscopic procedure is converted to open. Medicare has long held that when this happens, only the open procedure may be billed. The new wording should make it easier to file modifier -22 claims in such situations.
 
Modifier -25. Chapter One of CCI revives a short-lived policy laid out in CCM 6.3 (October 2000) that required appending modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to "significant, separately identifiable" E/M services performed on the same day as a diagnostic test.  The policy shift that came with CCM 6.3 prompted thousands of new edits, all of which were suspended in January 2001 due to confusion among carriers and physicians dealing with the new edits.
 
Although CCM 7.3 does not reintroduce the edits, it restates the policy in Chapter One/Sections D and H2 of CCI: "Many of these XXX procedures are performed by physicians and have inherent pre-procedure, intra-procedure and post-procedure work usually performed each time the procedure is completed. This work should never be reported with a separate E/M code With most XXX procedures, the physician may, however, perform a significant and separately identifiable E/M service on the same day of service which may be reported by appending the -25 modifier to the E/M code."
 
Many practices, says Elliott, reported an E/M service performed at the same time as a diagnostic test only if it was significant and separately identifiable. For these practices, the only change will be to remember to append modifier -25. Other practices never stopped appending modifier -25, even after the original edits were suspended, Elliott adds.
 
Note: Check upcoming editions of local Part B bulletins for more information on how local carriers are implementing the [...]