Radiology Coding Alert

CCI version 13.2 takes aim at 3 different specialty areas If you code for diagnostic, vascular or pain procedures, Correct Coding Initiative (CCI) version 13.2 has changes you don't want to miss. Don't forget: These edit additions and deletions are effective July 1. Get Hip to Whom This 73530 Edit Affects CCI 13.2 bundles 73530 (Radiologic examination, hip, during operative procedure) into a long list of pelvis and hip joint surgical codes. But these edits aren't the giant hit on physician reimbursement that they might seem at first glance. The edits: The nonmutually exclusive 13.2 edits bundle 73530 into the following pelvis and hip joint codes from CPT's Musculoskeletal System chapter: • incision codes 26990-27036 • excision codes 27040-27080 • introduction or removal codes 27086-27096 • repair, revision and/or reconstruction codes 27097-27187 • fracture and/or dislocation codes 27193-27266 • manipulation code 27275 • arthrodesis codes 27280-27286 • amputation codes 27290-27295. These new edits have modifier status "0," which means you can't override them with a modifier, says Jackie Miller, RHIA, CPC, senior coding consultant with Coding Strategies Inc., based in Powder Springs, Ga. Good news: CCI edits apply only to procedures performed by the same provider, so these new 73530 edits won't affect your ability to code a radiologist's interpretation of a hip x-ray taken during surgery performed by an orthopedist, Miller says. Hospital note: Next quarter, if CMS adopts these edits without change for hospital use, the edits will prevent Medicare payment to the hospital for hip x-rays performed during outpatient hip surgery, Miller says. Remember Edit Reimbursement Rules Nonmutually exclusive edits are also known as column 1/column 2 edits and were formerly called comprehensive/component edits. If you report both the column 1 and column 2 codes of a bundled pair, payers that adopt CCI edits will pay you only for the more extensive procedure (typically the column 1 code). On the other hand, CCI edits also include mutually exclusive edits, which pair procedures or services a physician would not reasonably perform during the same session at the same anatomic location on the same beneficiary, says Kelly Dennis, MBA, CPC, ACS-AP, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. If you were to report two mutually exclusive codes for the same patient during the same session, payers would pay for the lower reimbursed procedure. Use 13.2 to Pump up Vascular Accuracy You've got another long list of edits involving two endovascular aortic aneurysm repair codes: • +0153T -- Transcatheter placement of wireless physiologic sensor in aneurysmal sac during endovascular repair, including radiological supervision and interpretation and instrument calibration • 0154T -- Noninvasive physiologic study of implanted wireless pressure sensor in aneurysmal sac following endovascular repair, complete [...]