Dermatology Coding Alert

Published on Mon Jan 16, 2006 PDF

Make sure your documentation justifies separate services

Brace yourself for a new round of National Correct Coding Initiative edits on Jan. 1.

NCCI version 12.0 adds a startling 59,080 new non-mutually exclusive edits and 465 new mutually exclusive edits. It deletes only 60 nonmutually exclusive edits.

The hardest hit codes in the new NCCI are the drug administration codes that take effect in January. Hydration code 90760 and initial infusion code 90765 each become components of 5,737 other codes. Injection code 90772 and IV push codes 90774 and 90775 each become a component of nearly as many codes, more than 5,700 each.

You'll be able to use a modifier to override some of these edits, but not all of them.

Some of these edits applied to last year's G codes, and CMS is just carrying them over to the new CPT codes, experts say. Eighty-four E/M codes also become components of 90760, 90765, 90772 and 90774. You can use a modifier to override all of those edits except the ones governing a level-one office visit (99211).

Check Modifier Indicator for Unbundling Rules

CPT 2006 introduced a number of new E/M codes, including subsequent intensive care code 99300, nursing facility care codes 99304-99318, and domiciliary, rest home or custodial care services codes 99324-99340. Now NCCI 12.0 makes these new E/M codes components of dozens of other codes.

Example: CPT 11719 (Trimming of nondystrophic nails, any number) now includes 99304-99310 and 99318-99337. The bundles carry modifier indicator "1," which means that you can report a subsequent intensive care code, nursing facility care code or domiciliary care code along with 11719 if the clinical circumstances make both services necessary.

Do this: Download the NCCI edits from the CMS Web site at www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp.