Pediatric Coding Alert

But you'll find good news about coding debridement.

In our December 2010 Pediatric Coding Alert, we explained to you how Correct Coding Initiative (CCI) edits work, and shared the fact that Medicaid providers will be using these edits to deny services performed concurrently. We also promised to update you when CMS releases its quarterly edits -- and that time has already arrived.

The CCI Version 17.0 edits were released in December, and include 19,822 new active pairs and 9.778 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in a Dec. 14 announcement.

Many of the new code pair additions involve CPT codes that debuted on Jan. 1, with CCI now halting payment if you report certain procedures together.

For instance, you'll find vaccine administration codes 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid])and 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]) bundled into 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 these edits. This edit prevents mixing and matching the new immunization administration codes with the old, established immunization administration codes when delivering multiple vaccines at the same visit.

In addition, CCI bundles the new subsequent observation care codes 99224-99226 into inpatient neonatal and pediatric critical care codes 99468-99476.

CCI Has Good News on the Modifier Front

Not all news coming out of the new edition of CCI is bad. Effective Jan. 1, you'll be able to use a modifier (such as 59, Distinct procedural service) to separate the edit bundling wound care management codes 97597-97602 into the newly-revised debridement codes 11042-11044. In the past, if your pediatrician performed both procedures on the same date of service, you could not collect for both no matter what, but now you will be able to if your documentation demonstrates the separate and distinct nature of the services and you append the appropriate modifier.

Swapped pairs: In addition, CCI did an about-face on several edits this round. In the past, if you reported 94660 (Continuous positive airway pressure ventilation) or 94662 (Continuous negative pressure ventilation) with an outpatient E/M code (99201-99215), CCI would reimburse you for the pressure ventilation and deny the E/M service. However, CCI version 17.0 now makes the E/M service the primary code, and the pressure ventilation code will be denied if you report the services together. No modifiers can separate these edits.

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