Medicare Compliance & Reimbursement

Just as quickly as several new CPT^® codes went into effect, the new edition of the Correct Coding Initiative (CCI) ensured that you can’t report them all together. CCI version 22.0, which went into effect on Jan. 1, impacts the following prolonged services codes:

• 99415 — Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
• 99416 — Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to code for prolonged service).

You should consider these codes included in Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory) and G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination). All of these edits include a modifier indicator of “1.”

Note: You should also consider these prolonged services codes (99415, 99416) included in 99497.

Finally, your preventive codes (9938x-9939x) and E/M codes (99201-99225) now include ventilation codes (94002-94004, 94660-94662). All of these edits include a modifier indicator of “0,” meaning you cannot separate these edits under any circumstances.