CCI Guidelines: A Wealth of Coding Information
The national Correct Coding Initiative (CCI) chapter guidelines are a great resource to find coding tips. To illustrate, here are three nuggets of coding knowledge found in just a single chapter (chapter 13) of the guidelines:
Blood Draws from Venous Access or Catheter Only Separate for Lab Services
Codes 36591 Collection of blood specimen from a completely implantable venous access deviceand 36592 Collection of blood specimen using an established central or peripheral venous catheter, not otherwise specifiedmay be reported under two circumstances, only, per CCI Chapter 13 Guidelines:
- The only non-laboratory service performed is the collection of a blood specimen by one of these methods
- The blood draw is performed for the purpose of a laboratory service
CPT® guidelines support this reporting by specifying: “Do not report 36591 in conjunction with other services except a laboratory service,” and “Do not report 36591 in conjunction with other services except a laboratory service.”
To illustrate, CPT Assistant (July 2011) offers the following example of proper application of 36592:
The registered nurse reviews the patient chart for orders and obtains a medical history (eg, chemotherapy-related history). The patient is greeted, gowned, and positioned for a blood draw. The blood draw is completed by the nurse, who (1) draws a 10-cc syringe full to discard, (2) draws a second syringe to collect the blood specimen, and (3) flushes the line. The nurse labels the blood specimen and places it in the appropriate container for transport to the clinical laboratory
Catheter Insertion Included in Most Global Surgical Packages
Per CCI Chapter 13 Guidelines, “The Medicare global surgery package includes insertion of urinary catheters.” The guidelines further explain, “CPT codes 51701-51703 (insertion of bladder catheters) shall not be reported with any procedure with a global period of 000, 010, or 090 days nor with some procedures with a global period of MMM.” Non-surgical services also may include insertion of urinary catheters. For example, per CPT® guidelines, pediatric and neonatal critical care service codes (99293-99296) include bladder catheterization (51701, 51702).
To distinguish among the three codes that describe insertion of urinary catheter, in circumstances when the service may be separately reported, CPT Assistant(January 2007; Volume 17: Issue 1) advises, “Code 51701 differs from codes 51702 and 51703 in that it describes the insertion of a nondwelling bladder catheter used for intermittent catheterization or catheterization to obtain postvoid residual, and then it is removed. Codes 51702 and 51703 describe the insertion of a temporary indwelling bladder catheter that remains in place for a period of time.”
When a Biopsy Is (and Is Not) Reported Separately with Removal
Often, biopsy will accompany a more extensive procedure to remove additional tissue at the same location. Per CCI Chapter 13 Guidelines, “The biopsy is not separately reportable if the pathologic examination at the time of surgery is for the purpose of assessing margins of resection or verifying resectability.” But, a biopsy may be separately billed in two specific circumstances:
- The biopsy is utilized for immediate pathologic diagnosis prior to the more extensive procedure, and the decision to proceed with the more extensive procedure is based on the diagnosis established by the pathologic examination. In such a case, modifier 58 Staged or related procedure or service by the same physician during the postoperative periodmay be reported to indicate that the biopsy and the more extensive procedure were planned or staged procedures.
For example, a surgeon performs an excisional biopsy of the breast (19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions) to examine an abnormal lump in the patient’s right breast. The resulting pathology report indicates a malignancy, which results in the decision to perform a partial mastectomy (19301 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)). Because the biopsy preceded, and prompted, the mastectomy, you may report both procedures (e.g., 19301, 19120-58).
- The biopsy is performed on a separate lesion, it is separately reportable. In such a case, the biopsy may be reported with anatomic modifiers (e.g., modifiers LT Left sideand RT Right side) or modifier 59 Distinct procedural service.
For example, the provider biopsies a lesion on the right breast, and also excises a lesion of the left breast. You might report the appropriate biopsy code with modifier RTand the appropriate excision code with modifier LT. Or, depending on payer preference, you might instead report the excision code (e.g., the more extensive procedure) without a modifier, and append modifier 59 to the appropriate biopsy code.
To download the CCI policy manual, which includes all the chapter guidelines, visit the CMS website and choose the “Medicare Policy Manual for Medicare Services” link, at the bottom of the page. As a bonus, you’ll find an article outlining the proper use of modifier 59 in the same list of downloads.