Orthopedic Coding Alert

Although orthopedics escaped the brunt of the Correct Coding Initiative (CCI) version 15.2's edits, you should be aware of new bundles associated with three areas:

• discographies

• fluoroscopies

• injections.

Also, neglecting modifier indicators could send your claim into denial land. A total of nine edits switched from allowing you to separate them with a modifier to never allowing a modifier whatsoever -- and it's up to you to highlight this change.

CCI's latest version, 15.2, took effect on July 1, and includes over 3,500 new edit pairs, according to Frank Cohen, senior analyst with MIT Solutions Inc., in a June 17 news release.

Remember: Medicare applies CCI edits to services reported by the same provider for the same beneficiary on the same date of service, says Barbara J. Cobuzzi, MBA, CPC,CPC-H, CPC-P, CHCC, senior coder and auditor for The Coding Network, and president of CRN Healthcare Solutions in Tinton Falls, N.J.

Each CCI code-pair edit includes a correct coding modifier indicator of "0" or "1." A "0" indicator means that you may not unbundle the edit combination under any circumstances, according to CCI guidelines. An indicator of "1" means that you may use a modifier to override the edit if the procedures are distinct from one another (for instance, if they occur in separate anatomic locations).

If you use 72295 (Discography, lumbar, radiological supervision and interpretation) with any frequency, then you should be aware of this new edit. Now 72295 is a component of 62287 (Percutaneous decompression of nucleus polposus). You won't be able to separate it with a modifier, because the modifier indicator is "0."

If you've ever viewed an updated CCI file, you probably know to expect new edits for fluoroscopy code 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71024 [e.g., cardiac fluoroscopy]). CCI version 15.2 is no different.

This time around, you should count 76000 as a component of your spinal surgery codes, including the 22000 and 63000 series. This shouldn't be hard to apply in your practice, because CPT coding policy already states that a fluoroscopy must be a stand-alone service for you to bill it out separately.

These edits all have a modifier indicator of "1," meaning you can separate them with a modifier (such as 59, Distinct procedural service) should your physician's documentation support it.

In rare circumstances, your physician may perform IV pushes. If that is the case, you should know many musculosketal surgical codes now will include the subsequent IV push add-on code +96376 (Therapeutic,prophylactic, or diagnostic injection [specify substance or drug]; each additional sequential intravenous push of the same substance/drug provided in a facility [List separately in addition to code for primary procedure]). They include (and are not limited to):

• application of multiplane, unilateral external fixation (20696-20697)

• computer-assisted surgical navigation (20985)

• artificial disc codes (22856, 22861, 22864)

• buttock fasciotomy codes (27027, 27057).

Rationale: Code +96376 is an add-on code that you can bill only with an initial IV push drug. For instance, you'll see that CCI already bundles 96374 (... intravenous push, single or initial substance/drug) and 96375 (... each additional sequential intravenous push of a new substance/drug ...) into the codes mentioned above. This change merely adds an additional "add-on" code to the already bundled code family.

This edit carries a modifier indicator of "1," which means you can separate this edit with an appropriate modifier (such as 59, Distinct procedural service) if the criteria for doing so are met.

Finally, you should be aware of modifier indicator changes. CCI 15.2 revised existing edits to change their modifier indicator status of "1" to "0," meaning you can no longer separate these edits with a modifier.

Here are the nine orthopedic edits this change affects:

62287 62290

63020 62291

63020 72285

63030 62290

63030 72295

63040 62291

63040 72285

63042 62290

63042 72295

Example: If your orthopedist performs 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/ or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar) and discography supervision code 72295, then you should only report 63030. Medicare (and payers who follow Medicare guidelines) will only reimburse 63030.