Medicare Compliance & Reimbursement

The latest version of the Correct Coding Initiative (CCI) spares almost no specialty, with more than 8,000 new edits that will affect your claims in 2008.

Effective Jan. 1, CCI bundles needle or intracatheter introduction code 36000 into 78 other codes, including injection codes such as 20555, fracture care codes like 27726-27267, and catheterization codes 32550-32551. You can use a modifier to separate most of these edits.

Biggest bundle: New neonatal initial hospital care code 99477 is bundled into a whopping 418 codes, according to Frank Cohen, CMPA, of CPA Health Partners in Clearwater, Fla. If you report 99477 with individual psychotherapy codes 90804-90828, therapy evaluation/re-evaluation codes 97001-97004, or scores of anesthesia or radiology codes, Medicare carriers will reject the 99477 charge. And 141 other codes (including almost all of the E/M codes) bundle into 99477 and are therefore not separately payable if you report them with neonatal initial hospital care.

Pulmonology hit hard: CCI now bundles intercoastal nerve injection codes 64420-64421 into more than 330 codes a piece, including many of the respiratory surgery codes. "The most logical rationale here is that physicians are using these nerve injections as local anesthesia with respiratory procedures, and they shouldn't bill the anesthesia separately in these cases," says Heather Corcoran with CGH Billing in Louisville, KY.

Also hurting pulmonologists is the edit bundling new thoracostomy code 32551 into 336 codes, while new thoracentesis code 32422 bundles into 323 other procedures. These two new codes bundle mainly into services from CPT's respiratory and cardiovascular sections (such as 33300-33335) with the rationale that they are "separate procedures." You can use a modifier to separate most of these bundles.

Column reversal: And rounding out the big news for pulmonology practices, several codes related to this specialty did a "column swap," jumping from column one to column two. For instance, 11 codes that used to be bundled into 31643 (bronchoscopy) have now been switched, meaning that 31643 is now bundled into those codes, including lung removal codes 32440-32488.

"This makes sense," Corcoran says, "because lung removal is obviously the more extensive service."