CCI Revisions:
Long-Standing Coding Policies Modified
Published on Tue Jan 01, 2002
Otolaryngologists and their coders will want to pay close attention to Correct Coding Manual version 7.3 (CCM 7.3), the latest version of the manual that compiles all changes to the Correct Coding Initiative (CCI), as it includes revisions to long-standing coding principles. Most of the changes that affect otolaryngologists appear in Chapter One of the CCI, entitled "General Correct Coding Policies."
Chapter One/Section B, for instance, clearly states that individual services are included with more "comprehensive" procedures because:
1. The service represents the standard of care in accomplishing the overall procedure.
2. The service is necessary to successfully accomplish the comprehensive procedure; failure to perform the service may compromise the success of the procedure.
3. The service does not represent a separately identifiable procedure unrelated to the comprehensive procedure planned.
Section C1 now refers to "removal of a cerumen impaction prior to myringotomy" as an included service, noting that removal of impacted cerumen is included in the myringotomy because "the cerumen impaction is precluding access to the tympanic membrane and its removal is necessary for the successful completion of the myringotomy." Similarly, "a cursory evaluation of the upper airway as part of a bronchoscopic procedure would not be separately reported as a laryngoscopy, sinus endoscopy, etc."
"Many experienced otolaryngology coders already apply these principles," notes Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and President of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. "Having it there in writing can only help coders deal with their carriers and with their otolaryngologists, who may believe the procedures in question should be billed separately."
Chapter One includes changes that may affect coding and billing practices more directly, specifically relating to biopsies and other endoscopic procedures, procedures involving multiple lesions and services with XXX global days and E/M services performed on the same day.
Cobuzzi recommends that otolaryngology practices become familiar with all CCI policies. "These guidelines, especially those in Chapter One, have a lot of important information for otolaryngology practices," she says. "They are easy to reference and cover many of the issues that physicians and coders find most confusing."
Modifiers
Modifier -25. A short-lived policy introduced in 2000 bundled E/M services with codes with XXX global days. Physicians complained about the numerous CCI edits that the policy generated, prompting CMS to suspend it after only a few months. The same policy, which requires that modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) be appended to significant, separate E/M services, has been revived. CMS has reformulated the policy via a back door, without reintroducing the edits themselves, Cobuzzi says. Chapter One states: "Many of these 'XXX' procedures are performed [...]
