New bundles under the National Correct Coding Initiative (NCCI) mean you won't be able to report epidural administration and other regional blocks during labor management with maternity codes.
Labor and Delivery Include Epidurals
NCCI 9.2 continues CMS' bundling of anesthetic codes. Prior to this version, several bundles appeared for epidural anesthesia, but you could bypass these bundled codes using an appropriate modifier if the documentation supported it, Witt says. With version 9.2, CMS has added four regional block procedures to almost all of the Maternity Care and Delivery codes beginning with 59100 (Hysterotomy, abdominal [e.g., for hydatidiform mole, abortion]). The difference this time is that you cannot bypass these bundles with a modifier, she points out. The four bundled procedures are the following:
Bone Density Studies Are Now Mutually Exclusive
There are only a few new "mutually exclusive" code edits in NCCI 9.2, mostly associated with bone density studies. If you bill mutually exclusive codes for the same patient on the same date, Medicare and many other carriers will only pay the code with the lower reimbursement value, says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia. This relationship does not appear to apply to the medicine-procedure code bundles. For this version, you can override only two of the mutually exclusive bundles for the comprehensive code 78350 with a modifier, she adds. The bundles are as follows: (please see the first chart at the top of this article)
Watch for 24 New Edits
Despite the relatively few new mutually exclusive edits, version 9.2 includes 24 new surgical comprehensive/component edits that will impact ob-gyn practices, Witt says. Medicare and those payers that follow NCCI will never pay all but three of these edits when you bill the codes together with a modifier.
There have also been changes to existing code bundles for the following comprehensive codes: (please see the third chart at the top of this article)
Medicare has permanently bundled three tissue ablation codes (76362, 76394 and 76490) into the Category III code 0009T (Endometrial cryoablation with ultrasonic guidance). For those physicians performing pulsed magnetic neuromodulation for incontinence, NCCI now bundles 97530 (Therapeutic activities, direct [one-on-one] patient contact by the provider [use of dynamic activities to improve functional performance], each 15 minutes) and 97533 (Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct [one-on-one] patient contact by the provider, each 15 minutes), but if the documentation shows they are separate, you can use a modifier to bypass the edit.
NCCI Edits , version 9.2, went into effect July 1. "Although the number of edits that will impact ob-gyn practices is not extensive, most of them represent services that Medicare will never pay for when billed together payment indicator '0' but the maternity code bundles may have far-reaching implications for obstetricians," says Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.
The new surgical bundles that allow you to use a modifier to bypass the edit meaning they have a "1" modifier indicator under NCCI are: (please see the second chart at top of this article)
The bundles that will never be paid affect code combinations billed with colposcopy, trachelectomy and vaginal hysterectomy. These edits have a "0" modifier indicator, Mulholland says, meaning they will not be paid under any circumstance:
Tie Up a Few Loose Ends
And version 9.2 includes 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) in ultrasound guidance for needle placement, but you can append a modifier to bypass the edit when indicated.