Pediatric Coding Alert

Plus: One edit will face 'swapped columns'

You may just be getting used to the new codes in CPT 2011, but the latest edition of CCI, effective April 1, intends to make some code pairings impossible. Medicaid payers will be using these edits to deny services performed concurrently, and some private payers also follow CCI rules when they determine which services to bundle together.

The Correct Coding Initiative (CCI) released version 17.1 in March, revealing 11,831 new edit pairs and 346 terminations, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a March 17 statement.

New bundles: Among the new edits that were instituted on April 1, you'll find that E/M code 99211, which is often used for a nurse's visit with a patient, is bundled into the new vaccine administration code 90460 ((Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component), and no modifier can separate this bundle.

The majority of the new CCI edits took effect on April 1, although some were published with retroactive dates. For more information on CCI edits, visit www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.