Medicare Compliance & Reimbursement

Critical care, nursing facility care bundled with radiation treatment.

Radiologists just can't seem to catch a break from the Correct Coding Initiative (CCI). First, version 12.1 bundled radiology codes with dozens of edits, and now 12.3 is singling out radiology for the bulk of its new edits. 

Evaluation & management (E/M) codes 99289-99337, 99341-99350, 99431-99440 and 99455-99456 will all become components of radiation treatment delivery codes 77401-77414 in October. Hypothermia code 99185 and E/M codes 99201-99233 become components of stereotactic code G0173. Also, physician "stand-by" code 99360 becomes a component of several radiology codes and G0173.

Meanwhile, E/M codes 99234-99285 all become components of radiation treatment code 77421 and some stereotactic codes. Some of these E/M codes also become components of critical care code 99291, and others also become components of radiation treatment codes 77416-77417.

E/M codes 99289-99350 become components of stereoscopic X-ray guidance code 77421 and proton beam/hyperthermia codes 77520-77620, plus stereotactic codes 0083T and G0173. Some of these E/M codes also become components of other stereotactic codes.

Also, 99290, 99292 and 99300 all become components of radiation treatment codes 77261-77370 and 77416-77418. Code 99290 becomes a component of 77422-77470, while 99300 just becomes a component of 77427-77470.

You can't use a modifier to override any of the above edits.

What the edits amount to: It just became impossible to bill for any kind of critical care, nursing facility care or home care alongside radiation therapy or radiosurgery.

Even with the 25 modifier, you can't bill for dozens of E/M codes along with hundreds of radiation treatment codes.

Interactive psychotherapy codes 90810-90815 will become components of all of the radiology codes from 77261 to 77525, except for a couple of unlisted codes. These psychotherapy codes are also components of stereotactic radiosurgery codes 0082T and 0083T and G0173, G0243, G0251, G0339 and G0340.

Psychotherapy codes 90804-90809, 90816-90822 and 90847 also become components of just the stereotactic radiosurgery codes.

Pharmacologic management code 90862 becomes a component of five radiation therapy codes and two stereotactic codes.
 
What the edits amount to: If your patient requires any counseling, therapy or medication management on the same date as a radiation treatment or stereotactic procedure, you can't bill for that care separately. And a modifier can't help you with any of these edits, either.

Also, new psychological testing codes 96102-96103 become mutually exclusive with 96101. And 96102 is mutually exclusive with 96103.

You can't bill new neuropsychological testing codes 96118-96120 together, unless you have a good reason to use a modifier.