Pediatric Coding Alert

Bonus:You may be able to resubmit bundled resuscitation claims.

Unlike most Correct Coding Initiative (CCI) packages that have folks groaning under budgetary constraints, the latest version should have you rejoicing about potential 99465 payments youre due.

Truth 1: Large Size Is Due to Anesthesia Edits

Version 15.1, effective April 1, contains 304,038 additions. The file is one of the largest Ive seen, says Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPCP, CIMC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

The official reason CMS has given for the size is a need to control anesthesia bundles.

Truth 2: Column E Requires Scrutinizing Dates

When you scan the CCIs new quarter deletion database, dont limit your search to pairs with termination dates of April 1 (column E). CCI 15.1 made several edit pairs retroactive to 1/1/2009. If you did not bill one of these pairs because you thought they were prohibited or billed one of these pairs and were not paid due to CCI, you may be able to receive payment, said Frank Cohen,MPA, senior analyst with MIT Solutions Inc. in his CCI 15.1 webinar.

Opportunity: You billed interrogation device evaluation (93294) with delivery room resuscitation (99465) for date of service between 01/01/2009 and 03/31/2009. If you were denied payment for this edit pair last quarter, you may want to resubmit your claim, Cohen says. Code 93294 (Interrogation, device evaluation[s] [remote], up to 90 days; single, dual, or multiple lead pacemaker system with interim physician analysis, review[s] and report[s]) is now allowed with 99465 (Delivery/birthing room resuscitation,provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output).

Truth 3: 15.1 Deletes Invalid Code Pairs

The edits also include removed bundles that the incorrect parenthetical note following 99465 triggered.CCI 15.0 had adopted edits based on CPTs misprinted instruction following 99465 that had incorrectly included 99465 with 99460, and 99468 and 99477 with 99465. The edits remove these bundles retroactive to Jan. 1.