Primary Care Coding Alert

April 1 edits also tighten up hemoglobin coding

The latest version of the National Correct Coding Initiative contains several edits you won't want to miss -- especially in the codes you use for patient vaccinations.

-Most of these edits seem to be trying to capture redundant codes and reduce redundant coding,- says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.

Coders should start observing the following edits on April 1, when NCCI 13.1 took effect:

 - 83036 (Hemoglobin; glycosylated [A1C]) is bundled into 83037 (... glycosylated [A1C] by device cleared by FDA for home use). When your FP performs both of these procedures in the same session, report only 83037. These edits have a -0- modifier indicator, meaning you can never report them separately for the same encounter, even with the use of a modifier.

 - 99456 (Work related or medical disability examination by other than the treating physician ...) is bundled into 99455 (Work related or medical disability examination by the treating physician ...). These are both codes for work disability evaluations. The bundle also has a -0- modifier indicator.
NCCI Tightens Up Vaccination Code Group

There are also several new bundles in the vaccine code family, Moore says. Code 90714 (Tetanus and diphtheria toxoids [Td] adsorbed, preservative free, when administered to 7 years or older, for intramuscular use) is bundled into 90698 (Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated [DTaP-Hib-IPV], for intramuscular use) with a modifier indicator of -1.-

The -1- means you can report both of these codes for the same encounter in certain situations -- and with modifier 59 (Distinct procedural service) attached to the component code.

Here are the other vaccine edits of note:

 The following codes are bundled into 90714:

 - 90700 -- Diphtheria, tetanus toxoids, and acellular   pertussis vaccine -

 - 90701 -- Diphtheria, tetanus toxoids, and whole cell pertussis vaccine -

 - 90702 -- Diphtheria and tetanus toxoids adsorbed ...

 - 90703 -- Tetanus toxoid adsorbed -

 - 90718 -- Tetanus and diphtheria toxoids (Td) adsorbed -

 - 90719 -- Diphtheria toxoid -

All of these edits contain a -1- modifier indicator with the exception of 90703 and 90718, which have modifier indicators of -0.- 

The following codes are bundled into 90715 (Tetanus, diphtheria toxoids and acellular pertussis vaccine [Tdap], when administered to 7 years or older, for intramuscular use):

 - 90698

 - 90700

 - 90701

 - 90702

 - 90703

 - 90714

 - 90718

 - 90719

All of these edits contain a -1- modifier indicator.

The following codes are bundled into 90720 (Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Hemophilus influenza B vaccine [DTP-Hib], for intramuscular use) and 90721 (Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Hemophilus influenza B vaccine [DTaP-Hib], for intramuscular use):

 - 90714

 - 90715

All of these edits contain a -1- modifier indicator.