General Surgery Coding Alert

Good news: The edits wont be a big drain on your practices reimbursement.

If the news about the huge set of new Correct Coding Initiative (CCI) edits for this quarter has your head spinning, dont worry. Youll only have a few edit pairs to worry about in your general surgery practice. Let our experts help you narrow your focus.

Edits Focus on Just 524 Unique Codes

Version 15.1, effective April 1, contains 304,038 additions. This has increased the total present-day CCI database to 629,107 edit pairs.

The file is one of the largest Ive seen, says Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPCP,CIMC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

The official reason CMS has given for the size is a need to control anesthesia bundles.

Despite the numerous edits, CCI aims its fire at a select few codes this round, with only 524 unique codes listed in column 2 of the new column 1/column 2 edit list, and only 48 codes make up the top 80 percent of those listed, said Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla., in a March 12 news release.

Avoid Lap Appy With Other Lap Codes

CCI 15.1 bundles 44970 (Laparoscopy, surgical, appendectomy) into: laparoscopic splenectomy code 38120; surgical laparoscopy codes 38570-38572 and 43644-43652; laparoscopic bariatric surgery codes 43770-43774; laparoscopic jejunostomy codes 44186-44187; laparoscopic enterectomy codes 44202, 44204-44212, and 44227; laparoscopic proctectomy codes 45395-45402; laparoscopic liver tumor ablation codes 47370-47371; laparoscopic cholangiography/cholecystectomy codes 47560-47570; surgical laparoscopy with biopsy codes 49321-49325; tube insertion codes 49440-49441; and laparoscopic hernia repair codes 49650-49651.

All of these bundles have a modifier indicator of 1, which means that you can override the edits using a modifier, such as modifier 59 (Distinct procedural service), if the clinical circumstances warrant.

Sort Through Multiple Surgical Bundles

The most commonly occurring codes in column 2 of the new non-mutually exclusive edits are 94250 (Expired gas collection, quantitative ...), 94680-94690 (Oxygen uptake, expired gas analysis ...), 95812-95819 (Electroencephalogram ...), and +96376 (Therapeutic, prophylactic, or diagnostic injection ...; each additional sequential intravenous push of the same substance/drug provided in a facility ...), all with 1.67 percent of the total (5,065 occurrences each), Cohen says.

Example: CCI bundles these codes into most of the procedures in the integumentary, musculoskeletal, and digestive sections of CPT. You can use a modifier to separate most of them if you can demonstrate that a separately identifiable, distinct procedure was performed.

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Most of the new edits bundle nerve block and injection codes (623xx and 644xx) into almost every surgical procedure code found in the 2009 CPT manual.

Additionally: Youll also face numerous new bundles listing almost every code in the integumentary section of the CPT manual, wound exploration and biopsy codes in the musculoskeletal section (20000-20251), and almost every surgical procedure in column 1.

The column 2 codes with a modifier indicator of 1 (indicating you may override the edit with a modifier when appropriate) include:

" venipuncture: 36400-36406, 36420-36425

" transfusion: 36430

" push transfusion: 36440

" arterial puncture/catheterization: 36600, 36640

" naso- or oro-gastric tube placement: 43752

" anesthetic agent injection: 64505-64530

" surface neurostimulator application: 64550

" ECG: 93000-93010, 93040-93042

" transesophageal echocardiography: 93318

" pulmonary services: 94002, 94200, 94250, 94680-94690, 94770

" electroencephalography: 95812-95822, 95829, 95955

" sequential IV push: +96376.

Column 2 codes with a modifier indicator of 0(indicating you may never override the edit) include: epidural or subarachnoid injection: 62310-62311 and anesthetic agent injection: 64400-64413, 64418-64449,64479, 64483.

On the plus side: In most cases, procedures such as injections performed during surgery would be included in the main surgical procedure anyway, so these edits shouldnt hurt too badly, says Heather Corcoran with CGH Billing in Louisville, Ky.