ED Coding and Reimbursement Alert

Updates to the National Correct Coding Initiative (NCCI) can be a real headache for physician practices, but everyone needs to stay on top of them, or that little headache could turn into a chronic migraine of rejected claims.
 
CMS, together with the National Technical Information Service, has released version 9.3 of the NCCI, which is effective for the last quarter of 2003 (Oct. 1 through Dec. 31). But experts say the new round of edits shouldn't take too much of a toll on emergency department (ED) coding.
 
That doesn't mean coders can afford to overlook them, however - because some of the new incompatible code pairs could have at least a modest impact. For example, three new edits could be important for emergency physicians who do ultrasound studies:

  76830 (Ultrasound, transvaginal) is bundled into 76856 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; complete)

  76830 is also bundled into 76857 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; limited or follow-up [e.g., for follicles])

  93307 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; complete) now includes 76604 (Ultrasound, chest, B-scan [includes mediastinum] and/or real time with image documentation). The edits assign a status indicator of "1" to these codes, so you can unbundle and separately report these services under appropriate circumstances.
 
In other edits, several E/M codes from the observation and emergency department families now include the following codes:

90862 - Pharmacologic management, including prescription, use, and review of medication with no more than minimal medical psychotherapy

94660 - Continuous positive airway pressure ventilation (CPAP), initiation and management

94662 - Continuous negative pressure ventilation [CNP], initiation and management. The edits assign a status indicator of "0" to these bundles, so you can never unbundled these procedures, regardless of the circumstances.
 
"The bundling of certain ultrasound codes represents an area of concern for us, but the overall impact of the additional edits on emergency medicine is not large," says Michael A. Granovsky, MD, CPC, FACEP. "The bundling of CPAP and pharmacologic management will also have some impact, but not much."