Medicare Compliance & Reimbursement

You may just be getting used to the new codes in CPT 2011, but the latest edition of CCI, effective April 1, intends to make some code pairings impossible.

The Correct Coding Initiative (CCI) released version 17.1 last week, revealing 11,831 new edit pairs and 346 terminations, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a March 17 statement.

New bundles: Among the new edits that will be instituted on April 1, you'll find that alcohol and/or substance abuse assessment codes G0396 and G0397 are bundled into most of the E/M codes (99201-99239). In most cases, you can use a modifier to separate these edits, assuming that the documentation confirms the separate and distinct nature of the services, and demonstrates medical necessity for both the visit and the substance abuse assessment.

You'll also find the alcohol and/or substance abuse screening and intervention codes 99408-99409 bundled into the E/M codes under CCI 17.1, and no modifier will separate these edits.

Modifier changes: In addition to debuting new code pair edits, CCI 17.1 also bars you from appending a modifier from specific edit sets. For instance, in the past you were able to append a modifier (such as 59, Distinct procedural service) to separate the edits bundling nerve block codes 64402-64405 and 64415-64417 into drainage device insertion code 0191T, but CCI version 17.1 puts an end to that. The modifier indicator for this code pair is now "0," which means that no modifier can separate the edits.

On the bright side, CCI makes modifier use possible with the edits bundling operating microscope code 69990 into new stereotactic computer-assistant navigational procedure codes 61781-61783. Whereas the modifier indicator on these bundles used to be "0," CCI 17.1 changes it to "1."

To read more about CCI edits, visit the CMS Web site. You can find the current listing of CCI edits, as well as the CCI policy manual, at www.cms.hhs.gov/NationalCorrectCodInitEd.