Medicare Compliance & Reimbursement

CCI 15.3 retroactively deletes hundreds of edit pairs,but institutes over 18,000 new bundles.

If you thought the last version of the Correct Coding Initiative (CCI) left no stone unturned in bundling moderate sedation, think again.

CCI's version 15.3, which takes effect Oct. 1, continues the trend, bundling 99148-99150 into most of the other CPT codes, and no modifier can separate the bundles.

Modifier changes: CCI 15.3 also ensures that you won't collect when you report thousands of bundles that previously had a "1" modifier (which meant that you could append a modifier to the bundled code and your carrier would possibly reimburse you for both codes).

"In total, there were 73,054 edit pairs reported with a modifier indicator change for this release," said Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla., in a Sept. 11 news release. "320 pairs went from an indicator of 0 (can't use a modifier) to 1 (may be able to use a modifier), while the remainder (72,734) went from a 1 to a 0."

Targeted in the change are scores of spine surgery codes. For instance, you can no longer use a modifier to separate the edits bundling 64415- 64417 (Nerve block) into hundreds of surgical procedures.

Good news: On the bright side, CCI deleted 706 edit pairs, meaning that those code pairs are no longer bundled. Even better, 27 of these edit pairs were deleted retroactive to Jan. 1, and 357 pairs were deleted effective April 1. "This means that, if you were denied payment due to these edit pairs in the past, you would likely be able to resubmit the claim for payment at this time," Cohen said in the news release.

For instance: The edits bundling venipuncture codes 36400-36406 into 22526 (Percutaneous intradiscal electrothermal annuloplasty) have been deleted retroactive to April 1. Plus, the edits bundling IV infusion codes 96360, 96365, 96372, 96374, and 96375 into 22526 were deleted all the way back to their effective date of Jan. 1.

"If you plan to resubmit any claims that were denied due to these nowdeleted edits, send them with a cover letter explaining why you are doing so," says Denise Paige, CPC, secretary of the AAPC's Long Beach chapter. "Otherwise they may be denied as duplicate claims."