Resubmit Denied Hip Arthrotomy Claims and Collect Your Reimbursement
Published on Sat May 19, 2007
NCCI 13.1 deletes one edit but enacts several new ones The National Correct Coding Initiative has unveiled its latest set of edits, which includes some good news for orthopedic surgeons who perform arthrotomy of the hip joint for biopsy during the same session as hip arthrotomy for drainage. First, the Good News Version 13.1 of the NCCI took effect April 1, and it includes 1,692 new edits. The new round of NCCI deletes 299 edit pairs, and 212 of those deletions were retroactive to the start of the year, says Frank Cohen with MIT Solutions Inc. in Clearwater, Fla. However, the one deletion that applies to orthopedic practices took effect March 31.
In the past, insurers would deny payment for 27030 (Arthrotomy, hip, with drainage [e.g., infection]) if you reported it with 27052 (Arthrotomy, with biopsy; hip joint). However, NCCI now deletes that edit, so you can report both codes together.
Keep in mind: The edit deletion doesn't mean you should bill these codes together if you don't have medical necessity. -In most cases, you-ll need two different ICD-9 codes -- one for the biopsy and another for the drainage,- says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky. Modifier Changes and New Edits Abound for E/M Services Modifier change: NCCI 13.1 also changes modifier indicators for another 132 edit pairs from -1- to -0,- meaning you can no longer override those edits with a modifier. These include edits bundling nursing facility/rest-home visit codes 99307-99310, 99324-99328 and 99334-99337 with observation codes 99218-99220 and 99234-99236.
In the past, if you had a good reason to bill these code pairs, you could use a modifier to explain why the services were separately identifiable and necessary. But now, Medicare has decided that you can never justify billing them together.
New E/M bundles: The NCCI also instituted new edits that bundle each new patient visit code from 99201-99205 with every lower-level code in the same series. You can't use a modifier to override those edits.
The same goes for initial observation codes 99218-99220, inpatient consultation codes 99251-99255, domiciliary/rest-home visit codes 99324-99337, and home visit codes 99341-99345.
Also, subsequent hospital care codes 99231-99233 are all bundled with initial inpatient service codes 99221-99223, and no modifier can override those edits, either. You also can't bill two different subsequent hospital visit codes for the same patient on the same day.
Possible rationale: Most coding experts agree that this follows Medicare's basic rule of bundling several E/M visits that occur on one day into one single E/M code. Coders really should not have been reporting multiple E/M codes -- especially from the same category -- together on the same date for the same patient, experts say. NCCI Bundles Disc Arthroplasties, Osteotomies When [...]
