Orthopedic Coding Alert

Heres why you shouldnt panic.

If youre feeling cross-eyed by the Correct Coding Initiative (CCI) version 15.1s release, then help is here.Not only should you view the spreadsheets differently than in the past, but you should narrow the new edits down to 524 unique codes, many of which wont have a huge impact on your coding practices.

First,Take a Large Picture View

Version 15.1, effective April 1, contains 304,038 additions. The file is one of the largest Ive seen, says Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H,CPC-P, CIMC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

The official reason CMS has given for the size is a need to control anesthesia bundles.

Heres The Edits That Are New

Good news: Despite the numerous edits, CCI aims its fire at a select few codes this round, with only 524 unique codes listed in column 2 of the new column 1/column 2 edit list, and only 48 codes make up the top 80 percent of those listed, said Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater,Fla., in a March 12 news release.

The top most commonly-occurring codes in column 2 of the new non-mutually exclusive edits are 94250 (Expired gas collection, quantitative ...), 94680-94690 (Oxygen uptake, expired gas analysis ...), 95812-95819 (Electroencephalogram ...), and +96376 (Therapeutic, prophylactic, or diagnostic injection; each additional sequential IV push of the same substance/drug provided in a facility), all with 1.67 percent of the total (5,065 occurrences each), Cohen says.

Example: CCI bundles these codes into most of the procedures in the integumentary, musculoskeletal, and digestive sections of CPT. You can use a modifier to separate most of them if you can demonstrate that a separately identifiable, distinct procedure was performed.

In most cases, procedures such as injections performed during surgery would be included in the main surgical procedure anyway, so these edits shouldnt hurt too badly, says Heather Corcoran, coder with CGH Billing in Louisville, Ky.

These Deleted Pairs Could Help

CCI deletes 36 edit pairs, which may be a boon if the now-deleted edits were problematic for your practice.

Example: Youll no longer face an edit barring you from reporting 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) with 64412 (Injection, anesthetic agent; spinal accessory nerve).

Want to know more? Download the complete list of CCI edits and the CCI Coding Policy Manual at www.cms.hhs.gov/NationalCorrectCodInitEd/.