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Anesthesia Coding Alert

NCCI 11.1 Update:

Incorporate These New Debridement, Arthrodesis Edits

Published on Tue May 17, 2005

Check the status indicator to determine what you can unbundle

If your pain management group helps with arthrodesis or debridement procedures, be sure to check out the most recent edition of the National Correct Coding Initiative (NCCI), version 11.1.

Coders who report arthrodesis should heed mutually exclusive and nonmutually exclusive edits related to the procedure. These edits shouldn't apply to most anesthesia practices, but they might affect pain management groups, says Mary Klein, CPC, with Panhandle Medical Group in Pensacola, Fla. Nonmutually Exclusive Edits Bundle Debridement, Arthrodesis Nonmutually exclusive edits in NCCI 11.1 list debridement procedures 11010 (Debridement including removal of foreign material associated with open fracture[s] and/or dislocation[s]; skin and subcutaneous tissues), 11011 (... skin, subcutaneous tissue, muscle fascia, and muscle) and 11012 (... skin, subcutaneous tissue, muscle fascia, muscle, and bone) as components of two arthrodesis procedures. The comprehensive arthrodesis procedures are:

22532 - Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic

22533 - ... lumbar.

Mutually Exclusive Edits Also Cover Arthrodesis Several mutually exclusive edits also include arthrodesis codes 22532 and 22533. Physicians can no longer report arthrodesis along with four instrumentation codes: 22849 - Reinsertion of spinal fixation device
22850 - Removal of posterior nonsegmental instrumentation (e.g., Harrington rod)
22852 - Removal of posterior segmental instrumentation 
22855 - Removal of anterior instrumentation. NCCI version 11.1 assigns a status indicator of "1" to these pairs of mutually exclusive and nonmutually exclusive edits. Because of this, you can separately report the codes under certain circumstances using modifier -59 (Distinct procedural service). However, special rules apply when you unbundled procedure codes that edits pair. Be sure you have the correct supporting documentation before reporting services this way.

NCCI 11.1 went into effect April 1. To see a complete list of edits, log on to the CMS Web site at www.cms.hhs.gov/physicians/cciedits/default.asp.
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