Primary Care Coding Alert

CMS released the national Correct Coding Initiative (CCI) edits version 8.0 effective Jan. 1, 2002. The new edits replace all preceding versions and remain in effect through March 31.  
 
The main changes affect the anesthesia (00100-01999) and surgery (10021-69990) sections of CPT. A few changes affect family physicians.
 
Skin debridement codes are:
11040 debridement; skin, partial thickness
11041 ... skin, full thickness
11042 ... skin, and subcutaneous tissue
11043 ... skin, subcutaneous tissue, and muscle
11044 ... skin, subcutaneous tissue, muscle, and bone.

   
They have been bundled with 97601 (removal of devitalized tissue from wound[s]; selective debridement, without anesthesia [e.g., high pressure waterjet, sharp selective debridement with scissors, scalpel and tweezers], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session). These edits include a superscript of 0, indicating they cannot be unbundled by any modifier or paid separately under any circumstances.
 
The E/M codes have been bundled with the central nervous system assessments/tests codes (96100-96117), the health and behavior assessment/intervention codes (96150-96155), and the medical nutrition therapy codes (97802-97804). E/M visits cannot be reported on the same day for the same patient with those code groups. However, most of these edits include a superscript modifier of 1, indicating that modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) may be used to override the edits if an office visit and some of these services are performed on the same day.
 
According to Medicare, CCI edits take precedence over any guidelines in CPT. Although private payers are not required to observe CCI edits, many do, either in whole or in part. Check with individual payers before billing.
 
Note: The CCI is available by subscription from the National Technical Information Service (NTIS) in print or as a CD-ROM in searchable (pdf) format. Contact NTIS for more information: 1-800-363-2068 or http://www.ntis.gov/products/hcfa.htm.