Primary Care Coding Alert

Plus: The latest NCCI edits target the new vent management codes

With more than 9,000 changes in the latest National Correct Coding Initiative quarterly update (version 13.0, effective Jan. 1), you could spend an entire month trying to determine how the edits will affect your family medicine practice.

Good news: We-ve done the work for you. Here is a rundown of the most important additions and deletions.

Look for New Nursing Facility Rules

NCCI 13.0 deletes edits that bundled 14 E/M codes into initial nursing facility visit codes 99304-99306. Unfortunately, it also changes the modifier status on edits that bundled another 49 E/M codes into 99304-99306. Previously, you could use a modifier to bill those E/M codes with 99304-99306, but now you can-t.

Although CPT states that all E/M services provided by the physician in conjunction with the nursing facility admission are considered part of the initial nursing facility care, it does not mention E/M services outside of the nursing facility visit.

Suppose your physician sees a patient for an office visit and for nursing facility care in the same day. In the past, your coder could report 99304 (Initial nursing facility care, per day ...) for the admission, along with 99213-59 (Office or other outpatient visit for the evaluation and management of an established patient; Distinct procedural service) for the office visit. However, you can no longer report the established patient E/M code, because the NCCI bundles it into 99304, and no modifier can separate them.

Vent Management Codes Take a Hit

The new edition of NCCI also bars you from billing the new vent management codes (94002-94005) with most E/M codes.

But this shouldn't surprise most family medicine coders, because the 2006 vent management codes (94656 and 94657) were bundled into most E/M services, with no chance to override using a modifier, says Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.

-The new edits simply reflect a change in CPT coding for vent management with 94656 and 94657 being deleted in 2007 in favor of the new codes, 94002-94005,- Moore says.