Ob-Gyn Coding Alert

Question:

New Mexico Subscriber

The Centers for Medicare and Medicaid Services developed CCI to prevent inappropriate payment of services that should not be reported together. If you are checking CCI for codes that might be bundled together, but you discover the two in question are not listed, ,the codes are most likely not bundled by Medicare. Keep in mind CMS has stated that not all bundles are published, especially when the bundle in question is clearly indicated as such in the CPT^® book.

But if the two codes you are looking at are not bundled in CCI or CPT^®, you would not need a CCI modifier, such as 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit when appropriate. Under CPT^® rules, multiple procedures that are not bundled would simply take a modifier 51 (Multiple procedures) or some other applicable modifier, depending on your billing circumstance. You would be sure to list your highest valued procedure first, followed by additional procedures, each taking a modifier 51.

Watch out: CCI is not the only editing software being used by payers. ClaimCheck is another one, and companies that use it do not publish their bundles. You should always check payer policy to be sure you are billing appropriately " especially if you have already received a denial for a service from them.

Be Aware: CCI has two major types of bundle types:

This is why it is important to be aware of the bundled type. You can download the current CCI bundles (which clearly indicate which code is column 1 and which is column 2) from the CMS website at: http://www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp. But remember, these bundles are revised every 3 months, so you need to keep current. The new versions are published on January 1, April 1, July 1 and October 1 of each year.