You learned how to use the new codes; now you have to apply these bundles.
You may just be digging in to your 2012 CPT
® book, but the Correct Coding Initiative (CCI) has already taken aim at some of the new codes by bundling them into existing codes effective Jan. 1.
Background: The CCI released version 18.0 at the end of 2012, revealing 15,530 new active pairs and 6,197 code pair deletions, said
Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in his analysis of the changes.
Take a moment to learn how CCI affects your paracentesis, EMG, pelvic exent, and colpopexy services. Here's the good news: Although you'll see a varied array of allowed modifier use, most of these edits reflect either CPT guidelines or common sense.
1. Pelvic Repair Edits Make Sense Because of 15777's Intent
New add-on code 15777 (
Implantation of biologic implant) gets the CCI 18.0 treatment, in that codes 45560, 57240-57265, and 57285 all bundle 15777.
This makes sense when you consider the intent of this code. CPT instructions tell you not to use this code instead of 57267 (
Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [List separately in addition to code for primary procedure]). In other words, you can and should use 57267 with codes 45560, 57240-57265, and 57285 when appropriate. The same is not true for 15777.
The modifier indicator is a "1," which means that you can separate this bundle with a modifier (such as, 59,
Distinct procedural service). "I can think of no instance, however, when a gyn surgeon would perform a pelvic repair procedure with a procedure that qualifies for 15777," says
Melanie Witt, RN, COBGC, MA, an independent coding consultant in Guadalupita, N.M.
2. Pick Apart These New Paracentesis Codes' Edits
Remember the new parancentesis codes 49082 (
Abdominal paracentesis [diagnostic or therapeutic]; without imaging guidance), 49083 (
... with imaging guidance), and 49084 (
Peritoneal lavage, including imaging guidiance, when performed)? While only a gyn-oncologist will probably have a need to report these codes, you should be aware of the bundles that affect them.
All of the abdominal hysterectomy codes (58150-58210), the pelvic exent procedure code (58240), and cancer codes 58950-58958 now bundle the new codes 49082-49084.
Some edits have a modifier indicator of "1," meaning you can separate them with a modifier, and others with a "0," meaning you cannot. "There's no rhyme or reason to it," Witt says. Specifically, you'll find the "0" indicator for bundles with codes 58152-58240, and 58956 and the "1" indicator for bundles 58150, 58950-58954, and 58957-58958.
In a nutshell: Basically, what these edits mean are that you can only bill the paracentesis or peritoneal lavage if the provider did it to diagnose the type of cancer before deciding whether to do the surgery.
3. Think Twice Before Reporting 95938 With EMGs
Electromyography studies (EMG) did not escape CCI 18.0's notice.
Codes 51784 (
Electromyography studies [EMG] of anal or urethral sphincter, other than needle, any technique) and 51785 (
Needle electromyography studies [EMG] of anal or urethral sphincter, any technique) now bundle new code 95938 (
Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs).
You can separate these services with a modifier (such as, 59), because these edits have a modifier indicator of "1." However, you will probably never do this. "I see no reason you would code these two together ??" unless the provider is testing the arms and legs at the time of a urodynamic test, which is absurd," Witt says.
4. Don't Miss These Pelvic Exent and Colpopexy Edits
You have two more edits that could affect your ob-gyn practice, but be cautious: one edit has a modifier indicator of "1" and the other a modifier indicator of "0."
The pelvic exent code 58240 (
Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube[s], with or without removal of ovary[s], with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof) now bundles 0288T (
Anoscopy, with delivery of thermal energy to the muscle of the anal canal [e.g., for fecal incontinence]).
This edit has a "1" indicator, meaning you can separate this edit with a modifier applied to 0228T. However, "if you are creating a colostomy—which the exent code includes—you would not be doing 0288T in addition," Witt said.
Lastly, 58294 (
Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele) now bundles 57283 (
Colpopexy, vaginal; intra-peritoneal approach [uterosacral, levator myorrhaphy]) which goes along with the CPT instruction. This has a "0" indicator, meaning you cannot separate this edit under any circumstances. This bundle exists because a provider repairs an enterocele when performing an uterosacral colpopexy, and you may not bill two methods to accomplish the same result.
To view the complete list of CCI edits, visit the CMS Web site at
www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.
