Medicare Compliance & Reimbursement

The Correct Coding Initiative (CCI) strikes again, with more than 300,000 changes and 4,305 new bundles affecting Part B providers effective July 1.

This time around, CCI aims most of its fire at the anesthesia codes, directing nearly half of Version 14.2's new edits to the codes in the 00100-01999 range.

For example: CCI now bundles 36555-36556 (Insertion of central venous access device) into 93503 (Swan-Ganz insertion), but you can append a modifier to the pair to break the edit.

"Anesthesiologists reporting these two procedures together will need to make certain they are documenting the location of the CVP and Swan Ganz (they must be clearly separate) to allow a 59 modifier (Distinct procedural service) to release the edit," says Kelly Dennis, MBA, CPC, ACS-AP, of Perfect Office Solutions in Leesburg, FL.

Spine: In addition, CCI will now bundle 0171T (Insertion of posterior lumbar spinous process distraction device) into more than 20 other spine codes, such as 22102 (Partial excision of lumbar component), 22214 (Osteotomy of one vertebral segment, lumbar) and 63012 (Lumbar laminectomy), among others. But you can use a modifier to separate the edits if your documentation supports its use.

E/M: Your carrier will ensure that you avoid reporting new code 90769 (Subcutaneous infusion for therapy or prophylaxis ...) with E/M codes. The new CCI version bundles 90769 into 99218-99239 and most of the codes in the 99251-99440 range, but you can override most of these edits by using a modifier.

"Allowing the modifier is basically saying that modifier 59 can be used if the observation or consult or nursing home visit is done at a different time than the infusion," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Health-care Solutions in Tinton Falls, NJ.

In addition to adding and deleting code bundles, CCI also uses its updates to announce whether you can append modifiers such as 59 (Distinct procedural service) to separate bundling edits.

In Version 14.2, CCI changes some of those modifiers.

Cardiovascular surgery: In previous versions of CCI, edits bundled 32603 (Thoracoscopy, pericardial sac) into 33265 and 33266 (Maze procedure), and you could not separate the edits, even if you used modifier 59.

But the new edition of CCI will allow you to append a modifier to separately report the codes when necessary. These codes, however, "are not typically billed together," says Terry Fletcher, CPC, CCS-P, CCS, CPC-EM, CPC-Cardio, CMSCS, CMC, a healthcare coding consultant in Laguna Beach, CA.

Radiology: CCI made the opposite change to the modifier for the edits bundling A4641 (Radiopharmaceutical, diagnostic, not otherwise classified) into 78811-78816 (PET imaging). Whereas you used to be able to separate these bundles by using a modifier, CCI 14.2 will no longer allow that effective July 1. Instead, you'll have no way to separately report these codes.

This edit is appropriate, says Kim French, CIC, director of interventional coding and reimbursement at Crouse Radiology Associates in Syracuse, NY.

"Practices should not be using A4641 to report the pharmaceutical for a PET scan and also would not be performing any other nuclear study on the same day as a PET," French says. "The only approved PET pharmaceuticals are Rubidium RB-82 (A9555), Ammonia N-13 (A9526), and Fluorodeoxyglucose F-18 FDG (A9552)."

Ob-gyn and urology surgeons have been struggling for more than five years with a set of CCI edits. But as of July 1, those edits will be deleted retroactive to January.

If you were anguished over the years-old edits that bundled 57287 (Sling removal or revision) and 57288 (Sling operation) into 57284 (Paravaginal defect repair), CCI deletes them retroactive to Jan. 1.

"Providers may hold their claims for the 57287 and 57288 services which would be denied if the NCCI edits were applied, or resubmit these claims after the correction is implemented on July 1, 2008," according to the April 2008 American College of Obstetrics and Gynecology Coding and Practice Management Update.`