Part B Insider (Multispecialty) Coding Alert
CCI Now Allows a Modifier to Separate Hundreds of Edits
But other new bundles that 16.0 has in store might put a dent in your reimbursement.
The Correct Coding Initiative (CCI) released version 16.0 earlier this week, revealing 24,060 new active pairs and 869 modifier changes, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a Dec. 8 announcement.
Good news:
CCI version 16.0 attempts to untangle at least one troublesome set of edits in its next round with the announcement that effective Jan. 1, you'll be able to use a modifier to separate the edits bundling E/M codes (99201-99215;99221-99223) into over 100 of the radiation oncology codes.For instance, if you currently report new patient E/M code 99204 with 77261 (Therapeutic radiology treatment planning; simple), Medicare will deny the E/M code and no modifier can separate the edits. However, CCI 16.0 makes the modifier indicator for these bundles "1," meaning you will be able to separate the edits with a modifier (such as 59, Distinct procedural service) in some situations.
The bad news:
The CCI will eliminate your chances of collecting for both pancreatotomies (48150-48154) and certain cholecystectomies (47605-47610). Although previous editions of the CCI edits gave these pairings a "1" indicator (meaning you could use a modifier to separate the edits,) the pairs are assigned a "0" indicator effective Jan. 1.Most of the new CCI bundles affect codes that debuted in CPT 2010. For example, you'll find over 100 codes bundled into new tumor excision code 25071 (3 cm or greater).
The fact that some skin surgery codes, such as 12001-12007 (Simple repair of superficial wounds) now bundle into the new tumor excision codes "makes perfect sense," says Randall Karpf, coding consultant with East Billing in Connecticut. "A simple repair can be done during the course of the excision, so you'd bundle it unless the separate encounter or site rules apply."
For a primer on CCI basics, turn to page 340.
Part B Insider (Multispecialty) Coding Alert
- CORRECT CODING INITIATIVE:
CCI Now Allows a Modifier to Separate Hundreds of Edits
But other new bundles that 16.0 has in store might put a dent in your [...] - CORRECT CODING INITIATIVE:
CCI Now Allows a Modifier to Separate Hundreds of Edits
But other new bundles that 16.0 has in store might put a dent in your [...] - MODIFIERS:
New Medicare Modifiers Throw Practices for a Loop
Key: Know how to report professional component. CMS introduced three new modifiers effective last January, [...] - MODIFIERS:
New Medicare Modifiers Throw Practices for a Loop
Key: Know how to report professional component. CMS introduced three new modifiers effective last January, [...] - COMPLIANCE:
OIG Recovered $21 Billion in 2009, With Plans to Stay 'Aggressive' Going Forward
OIG keeps ophthalmology services, chiropractic, and ultrasound on its radar screen, along with other Medicare [...] - COMPLIANCE:
OIG Recovered $21 Billion in 2009, With Plans to Stay 'Aggressive' Going Forward
OIG keeps ophthalmology services, chiropractic, and ultrasound on its radar screen, along with other Medicare [...] - CCI:
Learn CCI Basics -- Or Watch Denials Flood In
Not overriding when you can means missing billable services. If you don't understand what Correct [...] - CCI:
Learn CCI Basics -- Or Watch Denials Flood In
Not overriding when you can means missing billable services. If you don't understand what Correct [...] - READER QUESTION:
Nail Down Sleep Study Type to Determine Coverage
Medicare has strict requirements about tests performed in the patient's home. Question: Our practice is [...] - READER QUESTION:
Nail Down Sleep Study Type to Determine Coverage
Medicare has strict requirements about tests performed in the patient's home. Question: Our practice is [...] - PART B CODING COACH:
Eliminate Ventilator-Associated Pneumonia Uncertainty With Clear Diagnosis Parameters
Tip: Other conditions 'mimic' ventilator-associated pneumonia and can lead to misdiagnosis. Ventilator-associated pneumonia (VAP) is [...] - PART B CODING COACH:
Eliminate Ventilator-Associated Pneumonia Uncertainty With Clear Diagnosis Parameters
Tip: Other conditions 'mimic' ventilator-associated pneumonia and can lead to misdiagnosis. Ventilator-associated pneumonia (VAP) is [...] - PHYSICIAN NOTES:
CMS Will Cover HIV Screening As Preventive Care Service Effective Immediately
Plus: FDA asks providers to be aware of potential dangers of negative pressure wound therapy [...] - PHYSICIAN NOTES:
CMS Will Cover HIV Screening As Preventive Care Service Effective Immediately
Plus: FDA asks providers to be aware of potential dangers of negative pressure wound therapy [...] - In other news ...
• If you're using negative pressure wound therapy (NPWT) devices (i.e., wound vacs), you'd better [...] - In other news ...
• If you're using negative pressure wound therapy (NPWT) devices (i.e., wound vacs), you'd better [...]
