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Primary Care Coding Alert

Birth and Blood Are Under Fire From NCCI

Published on Thu May 01, 2003

The latest version of the National Correct Coding Initiative (NCCI) targets obstetric and laboratory codes and requires family physician coders to focus on two bundles that reinforce coding conventions.

Although NCCI 9.1 is large, with almost 3,000 additions and 2,000 deletions, the edits will probably not shock you, says Daniel S. Fick, MD, director of risk management and compliance for the College of Medicine faculty practice at the University of Iowa in Iowa City. Instead, the most recent round of edits, the first since the incorporation of the new 2003 CPT codes, clarifies E/M reporting and reinforces coding to the highest specificity. NCCI 9.1, effective April 1-June 30, bundles:

  • cesarean and postpartum care (59515) with cesarean delivery (59514)
  • LDLcholesterol (83721) with lipid panel (80061) and total cholesterol (82465).

    Ob Bundle Is No New News

    At first glance, you may be dismayed to see this first edit, which includes 59514 (Cesarean delivery only) with 59515 ( including postpartum care). "But, these ob edits are fairly obvious," says Kent Moore, American Academy of Family Physicians manager of Health Care Financing and Delivery Systems, Leawood, Kan.

    NCCI created the bundle based on the two codes being separate procedures. The family physician (FP) performs one or the other because, by definition, he can't provide both the delivery only and the delivery and postpartum care, Fick says.

    For instance, suppose a physician performs cesarean delivery only. By definition, he cannot also provide postpartum care. Similarly, if he provides postpartum care in addition to the delivery, he can't report delivery only. Consequently, based on coding principles, which require coding to the highest specificity possible, you would choose either cesarean delivery only (59514) or cesarean delivery including postpartum care (59515). In fact, billing both codes would mean the doctor would be billing for the delivery twice, Moore say.

    Two Tests Include Bad Cholesterol

    Although the ob bundle confirms earlier CPT tenets, the pathology and laboratory edits break new ground. NCCI 9.1 includes 83721 (Lipoprotein, direct measurement; direct measurement, LDL cholesterol) as a component of 80061 (Lipid panel; this panel must include the following: cholesterol, serum, total [82465]; lipoprotein, direct measurement, high density cholesterol [HDL cholesterol] [83718]; and triglycerides [84478]) and 82465 (Cholesterol, serum or whole blood, total).

    The lipid panel edit may be confusing because it bundles a service that is not directly referenced in the panel. Code 80061 contains the test for high-density lipoprotein (HDL), "good cholesterol" (83718), but not low-density lipoprotein (LDL), "bad cholesterol" (83721). Therefore, you may think billing 83721 in addition to 80061 is acceptable. But, a clinical reason exists for the edit. "If you have the other components of 80061, you can calculate LDL," Fick explains. Consequently, NCCI considers billing both codes together a misuse, an action that the College of American Pathologists (CAP) supports.

    Despite backing the initial edit, CAP disagrees with the second bundle. Although LDL can be calculated from the HDL and triglyceride components of 80061, physicians cannot evaluate 83721 from 82465 alone. Regardless of the organization's interpretation, NCCI disallows separately billing for the LDL test (83721), which it includes in total cholesterol chemistry (82465).

     

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