Primary Care Coding Alert

The National Correct Coding Initiative, version 10.2, goes into effect on July 1, and while the edits shouldn't be too burdensome for family medicine practices, you'll need to keep an eye on a few new bundles for fetal monitoring.

The biggest and best news from the latest NCCI edits is that "family medicine practices don't have to worry about anything being bundled into their office visits" because 10.2 contains no changes to the E/M codes, says Jean Acevedo, CPC, LHRM, senior consultant, Acevedo Consulting Inc.

Still, there are a few codes that can cause unwary FPs some big trouble.

First, NCCI 10.2 has bundled bladder catheterization codes 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]) and 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]) into the following maternity care codes:

59020 -- Fetal contraction stress test
59025 -- Fetal non-stress test
59030 -- Fetal scalp blood sampling
59050 -- Fetal monitoring during labor by consulting physician (i.e., non-attending physician) with written report; supervision and interpretation
59051 -- ... interpretation only.

According to Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians, these edits could be problematic. "Bladder catheterization is not a component service of these fetal evaluation or monitoring techniques," he says, and also notes that these two services are not mutually exclusive and could be performed during the same clinical encounter. For example, a woman in labor may need both fetal monitoring and insertion of a bladder catheter, he says, in which case the services should be separately billable. With a status indicator of "0," which all of the above edits have been assigned, there are no circumstances under which NCCI says you can separately report these services.

Another key edit is the bundling of 89220 (Sputum, obtaining specimen, aerosol-induced technique [separate procedure]) into 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]). NCCI assigned a status indicator of 1 to this bundle, indicating that under the proper circumstances you may be able to report each service separately when performed during the same session. But Moore doesn't see that happening. "We cannot identify a clinical situation in which it would make sense for the same provider to provide 94640 and 89220 to the same patient on the same date of service," he says.

Don't overlook: The latest edits also reinforce the guidelines that you cannot report lidocaine used as local anesthesia for any procedures other than those used to treat cardiac arrhythmia. CMS tried to put a stop to practices reporting lidocaine with non-cardiac service by deleting the popular J2000 (Injection, lidocaine HCl, 50 cc) in HCPCS 2004 and replacing it with the more specific code J2001 (Injection, lidocaine HCl for intravenous infusion, 10 mg).

NCCI 10.2 takes the lidocaine crackdown a step farther and bundles J2001 into hundreds of CPT codes. For example, if an FP performs an arthrocentesis, coders cannot report the supply of the drug separately, says Mary Falbo, MBA, CPC, president of Millennium Healthcare Solutions.

Note: To view the NCCI edits free online, go to www.cms.hhs.gov/physicians/cciedits/default.asp. The same Web page also includes links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.