Medicare Compliance & Reimbursement

No modifier will overcome 13.3's hundreds of new surgery edits

Bad news: You can pretty much give up on billing some rectum and anus surgery codes with a number of other surgery codes, under any circumstances.

The Correct Coding Initiative version 13.3 creates a number of bundles involving:

• rectum manipulation codes 45900-45915;

• 46040 (I&D of ischiorectal and/or perirectal submuscosal abscess, transanal, under anesthesia) and 46080 (Sphincterectomy, anal, division of sphincter); and

• anal excision codes 46200-46220.

CCI gives these edits a modifier indicator of "0," so you cannot use a modifier to override the 589 edits that bundle those codes into many others.

For example: Codes 45900-45915 will be components of rectal surgery codes 45000-45190 come Oct. 1. Also, 46040, 46080 and 46200-46220 will become components of almost all of the codes from 45000-45190.

CPT codes 46040, 46080 and 46200-46211 also will become components of most of the anal surgery codes in 46500-46947. Codes 45900-45915 will be components of 46040 and hemorrhoid surgery code 46320.

Also, 46040, 46080 and 46210-46211 all become components of rectal endoscopy codes 45300-45392. Meanwhile, 46040 and 46210 become components of 45500-45825. And 46080 and 46211-46220 also become components of some of those codes. Code 46220 becomes a component of anorectal exam code 45990.

Another set of edits makes it impossible to bill many of the anal surgery codes in 46020-46083 with the other codes in that same series. And 46210 becomes a component of most of those anal surgery codes, plus most of the hemorrhoid surgery codes in 46221-46285.

Also, you can't bill for any one of those rectum manipulation codes (45900-45915) with any of the others. For example, 45905-45915 are components of 45900.

Bottom line: Rectal manipulation codes 45900-45915, anal surgery codes 46040 and 46080 and anal excision codes 46200-46220 will become impossible in October. You won't be able to bill these codes with many commonly performed procedures--even with a modifier.

Don't Look For Closure Payments

Watch out: CPT codes 12001-12007, for simple repair of superficial wounds, become components of four dozen codes each from the musculoskeletal system section in the latest CCI update.

In a nutshell: Thanks to CCI, you probably can't bill for one of those superficial wound repair codes at the same session as a deep excision, a tissue graft, a radical tumor resection, a deep incision and drainage (I&D), a radical resection, a spine surgery or a lesion excision.

Layered wound closure codes 12031-12037 and 12041-12047 will also become components of most of the same surgical codes.

Complex wound repair codes 13100-13132 (except for the add-on codes) are also slated to become components of a couple of dozen surgical codes.

Similarly, superficial facial wound repair codes 12011-12018 became components of a number of surgical codes, including several facial fracture care codes. Layered facial wound repair codes 12051-12057 and complex facial wound repair codes 13150-13152 will be components of many of the surgical (and facial fracture care) codes as well.

You can use a modifier to override those edits, but be prepared to justify the need for a separate wound repair.

CPT codes 12020-12021, for treatment of superficial wound dehiscence, also became components of around 58 surgical codes. You can use a modifier to override these edits.

Ensure Documentation Supports Separate E/M

CPT 2007 introduced 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour) to cover aerosol inhalation treatments in your office. Now CCI 13.3 bundles 94644 into 53 evaluation and management codes. You can use a modifier to unbundle this edit if you can prove the E/M visit really was separate.

Meanwhile, aortography codes 75600-75605 and pulmonary angiography codes 75741-75756 all become components of cardiac catheterization codes 93501-93533 and pulmonary angiography code 93556. A modifier will rescue you from the edits bundling 75600-75605--but not from the pulmonary angiography edits.

More new CCI edits:

• Spinal manipulation code 22505 becomes a component of most of the codes in the spinal surgery section from 22532 to 22865.

• Dural/cerebrospinal fluid leak repair codes 63707-63709 become components of most of the codes in the 63001-63307 section.