Medicare Compliance & Reimbursement

On the radar: CCI aims its fire at a select few codes this round, with only 524 unique codes listed in column 2 of the new column 1/column 2 edit list, and "only 48 codes make up the top 80 percent" of those listed, said Frank Cohen, MPA, senior analyst with MIT Solutions, Inc. in Clearwater, Fla., in a March 12 news release.

The top most commonly-occurring codes in column 2 of the new non-mutually exclusive edits are 94250 (Expired gas collection, quantitative), 94680-94690 (Oxygen uptake, expired gas analysis), 95812-95819 (Electroencephalogram), and 96376 (Therapeutic, prophylactic, or diagnostic injection; each additional sequential IV push), all with 1.67 percent of the total (5,065 occurrences each), Cohen says.

For example: These codes are bundled into most of the procedures in the integumentary, musculoskeletal, and digestive sections of CPT. You can use a modifier to separate most of them if you can demonstrate that a separately identifiable, distinct procedure was performed.

"In most cases, procedures such as injections performed during surgery would be included in the main surgical procedure anyway, so these edits shouldn't hurt too badly," says Heather Corcoran with CGH Billing in Lousiville, Ky.

Deleted pairs: CCI deletes 36 edit pairs, which may be a boon if the now-deleted edits were problematic for your practice.

For example: You'll no longer face an edit barring you from reporting 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve) with 64412 (Injection, anesthetic agent; spinal accessory nerve).

In addition, CCI has deleted the edits bundling nervous system codes 62318-62319, 64415-64417, 64450, 64470, and 64475 into 64550 (Application of surface [transcutaneous] neurostimulator).