Medicare Compliance & Reimbursement
Why You Can't Use A Modifier To Override SRS Edits
CPT 2007 brings a number of new procedure codes, and just as quickly, Correct Coding Initiative (CCI) Version 13.0 brings a number of edits.
More than half of the 9,610 new code pairs in CCI 13.0 involve new surgical codes. In the past, most of the CCI edits have dealt with anesthesia codes, but this time around the balance has shifted to surgical procedures, says Frank Cohen with CPA Health in Clearwater, FL, who analyzes the CCI edits for payers and providers.
The new edits aim to keep you from unbundling procedures your physician does as part of a surgery. For most of the new procedures, CCI 13.0 will prevent you from billing separately for anesthesia, wound repair, casts, catheterization, nerve block, operating microscope, fluoroscopy, hydration and tests.
The most heavily affected codes are:
· New thoracic spine and cord anesthesia codes 00625-00626 (242 new Component codes, 14 Comprehensive codes). You can't bill most evaluation & management (E/M) codes with these codes, even using a modifier. Other common procedure, injection and nerve block codes are bundled into these codes, but you can override those edits with a modifier. Also bundled into these codes are several laryngoscopy codes, ventricular puncture codes and epidural injection codes.
· New surgical preparation of donor site codes 15002-15004 (99-104 new Component codes, 12-17 Comprehensive codes). Virtually every wound repair code becomes a component of these new codes, and so do skin debridement codes 11040-11044, skin biopsy code 11100 and various injection/nerve block codes.
· New Mohs microsurgery codes 17311-17313 (69 new Component codes). Malignant lesion excision codes 11600-11646 all become components of these codes, and so do pathology codes 88300-88314, 88331-88332 and 88342.
· New nerve repair codes 64910-64911 (72 Component codes). Not surprisingly, a number of nerve block codes become components of these, and so do neuroplasty codes 64702-64726--and every neurorrhaphy code from 64831-64870 except for add-on codes. Also, 18 codes from the electromyography/nerve conduction tests and evoked potentials/reflex tests sections become components of these codes.
· New stereotactic radiosurgery codes 77371-77373 (118-128 Component codes, 48-58 Comprehensive codes) and stereotactic body radiation therapy code 77435 (78 Component codes). A surprisingly large number of these edits won't allow a modifier, including ones bundling tattooing codes 11920-11921, burn treatment codes 16000-16030, bladder catheterization codes 51701-51703, stereotactic volumetric procedure code 61795, stereoscopic X-ray guidance code 77421, 21 psychotherapy and behavior assessment codes, medical nutrition therapy codes, and 33 E/M codes.
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