Primary Care Coding Alert

Prepare for edits to strapping, nebulizer services -- and more

Find out when and how to break payment bundles for I&D, continuous inhalation treatment, and home apnea monitoring with these insider secrets.

1. Include Applying Dressing in I&D

If your FP performs an incision and drainage (I&D) and then applies an Unna boot, you may have to reduce your coding from two procedures to one.

No bundling issues now exist on these procedures, says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates. But that's going to change for payers that follow Correct Coding Initiative (CCI) edits.

Starting April 1, new version 14.1 puts an end to also coding the strapping (29580, Strapping; Unna boot). The CCI edits bundle Unna boot strapping code 29580 into five I&D codes and one debridement code:

- 10060 -- Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single

- 10061 -- - complicated or multiple

- 10140 -- Incision and drainage of hematoma, seroma or fluid collection

- 10160 -- Puncture aspiration of abscess, hematoma, bulla, or cyst

- 11000 -- Debridement of extensive eczematous or infected skin; up to 10% of body surface.

Exception: You may report an Unna boot strapping with the above codes when the procedures occur on separate sites. "The edits permit you to use modifier 59 (Distinct procedural service) to break the bundle under extenuating circumstances, such as different anatomical sites, supported with documentation," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

2. Choose Treatment Code Based on Time

Beware of one new bundle when coding inhalation treatments. You should not report an individual inhalation treatment, such as with a nebulizer, in addition to continuous inhalation treatment.

CCI makes inhalation treatment code 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) a component of the more extensive 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour).

Warning: The edits do not allow you to override the bundle under any circumstances. Choose the correct code based on time following these guidelines:

- Use 94640 for intermittent inhalation treatment of less than 1 hour.

- Restrict 94644 only to procedures lasting at least 60 minutes, according to Medical Learning Inc.'s respiratory compliance experts.

3. Use 59 on ECG Unrelated to Monitoring

How many medicine codes should you report if your FP interprets results from an electrocardiogram (ECG) and home apnea monitoring recording? The answer is one, CCI 14.1 says. Pediatric home apnea monitoring (94774-94777) includes a related ECG (93000-93010).

Code 94774-94777 bundles also apply to telephonic transmission (93012-93014), ECG rhythm strips (93040-93042), pediatric pneumogram (94772), and sleep testing (95805).

The edits bring CMS in line with CPT. The AMA's CPT Changes 2007: An Insider's View states that "94774 includes attaching the monitor, downloading the data, reviewing and interpreting the data by a physician, and preparation of the report," says Jill M. Young, CPC-ED, CPC-IM, president of Young Medical Consulting LLC in East Lansing, Mich. "Any -downloading of data- whether on-site or an electronic transmission would be included."

Because the monitors relay ECG information, the monitoring includes the ECG component -- a fact the CPT manual asserts. "Parenthetical notes after the 94774-94777 section address not billing for ECG and an apnea recording device," Young says. The edits have a 1 indicator, meaning if the physician orders the monitoring and the cardiovascular/pulmonary testing at different sessions, you could report the test code appended with modifier 59 (Distinct procedural service).