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Practice Management Alert

Reader Question:

Catch Up With CCI Edits

Published on Thu May 01, 2003

Question: We deal with frequent denials because of bundled services. We want to be ahead of insurers this time. What are the National Correct Coding Initiative (NCCI) edits from version 9.1 that we should watch for on our claims?

California Subscriber

Answer: You can never review the most recent NCCI edits too early. Here are highlights from the recent NCCI edits that will affect specific specialties:

Ob-Gyn: Of the 55 new bundles for ob-gyn services, there are only five that CCI permits you to unbundle with a modifier:

  • 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) and evaluation and management of an established patient, level one, 99211

  • 52000 (Cystourethroscopy [separate procedure]) and 51700* (Bladder irrigation, simple, lavage and/or instillation)

  • 57421 (Colposcopy of the entire vagina, with cervix if present; with biopsy[s]) and 57456 (Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage), 57460 (... with loop electrode biopsy[s] of the cervix), 57461 (... with loop electrode conization of the cervix).

    Arthroscopy: The NCCI edits bundle 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage) and 29874 (... for removal of loose body or foreign body [e.g., osteochondritis dissecans fragmentation, chondral fragmentation]) into several additional knee surgery codes. You can still receive reduced payment for the new bundled services reporting the new HCPCS code G0289 (Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage [chondroplasty] at the time of other surgical knee arthroscopy in a different compartment of the same knee).

    Otorhinolaryngologic: The NCCI edits bundle 99211 with 92504 (Binocular microscopy [separate diagnostic procedure]), 92526 (Treatment of swallowing dysfunction and/or oral function for feeding), 92541 (Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording)

  • 92506 (Evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status) and 92507 (Treatment of speech, language, voice, communication, and/or auditory processing disorder [includes aural rehabilitation]; individual) with 92601-92604 (Diagnostic analysis of cochlear implant)

  • 92520 (Laryngeal function studies) with 92612-92616 (Flexible fiberoptic endoscopic evaluation ).

    Family Practice: NCCI edits for pathology and laboratory: 80061 (Lipid panel) now include 83718 (Lipoprotein, direct measurement; high-density cholesterol), 83721 ( direct measurement, LDL cholesterol), 82465 (Cholesterol, serum or whole blood, total), 84478 (Triglycerides).

    Anesthesiology: The new edits continue to bundle pain management injection codes with other services. Nonmutually exclusive edits bundle gastrointestinal (GI) anesthesia with the GI procedures, including diagnostic and surgical procedures with biopsy, removal of foreign body, control of bleeding, and removal or ablation of tumors of other lesions by various techniques.

     

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