Otolaryngology Coding Alert

Most new bundles wont affect your bottom line.

If the news about the huge set of new Correct Coding Initiative (CCI) edits for this quarter has your head spinning, dont worry. You'll only have a few edit pairs to worry about in your otolaryngology practice. Let our experts help you narrow your focus.

Version 15.1, effective April 1, contains 304,038 additions. This has increased the total present-day CCI database to 629,107 edit pairs.

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.

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.

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 of CGH Billing in Louisville, Ky.

One thing to watch out for: 43752 (Naso- or orogastric tube placement, requiring physicians skill and fluoroscopic guidance [includes fluoroscopy, image documentation and report]) is now bundled into numerous codes. That probably wont come up too often during a rhinotomy (30118, Excision or destruction [e.g., laser], intranasal lesion; external approach [lateral rhinotomy]) but its bundled just the same.

Additionally: New edits bundle nerve block and injection codes (623xx and 644xx) into almost every surgical procedure code in the 2009 CPT manual. Youll also face numerous new bundles listing almost every code in the integumentary section of the CPT manual, wound  exploration and biopsy codes in the musculoskeletal section (20000-20251), and almost every surgical procedure in column 1.

The column 2 codes with a modifier indicator of 1 (indicating you may override the edit with a modifier when appropriate, which usually means that the column 2 procedure was done on a separate site or at a separate encounter or operative session) include:

" venipuncture: 36400-36406, 36420-36425

" transfusion: 36430

" push transfusion: 36440

" arterial puncture/catheterization: 36600, 36640

" naso- or oro-gastric tube placement: 43752

" anesthetic agent injection: 64505-64530

" surface neurostimulator application: 64550

" ECG: 93000-93010, 93040-93042

" transesophageal echocardiography: 93318

" pulmonary services: 94002, 94200, 94250, 94680- 94690, 94770

" electroencephalography: 95812-95822, 95829, 95955

" sequential IV push: +96376.

Column 2 codes with a modifier indicator of 0 (indicating you may never override the edit) include: epidural or subarachnoid injection: 62310-62311 and anesthetic agent injection: 64400-64413, 64418- 64449,64479, 64483.