General Surgery Coding Alert

'Standards of surgical practice' lead edit pairs for many procedures.

Infusions, punctures, blocks, heart/lung monitoring, radiology ... it's all part of the surgical package, according to Medicare. Just to make sure you believe it, the latest edition of Correct Coding Initiative (CCI), effective April 1, intends to block many surgical code pairings with these services.

The Correct Coding Initiative (CCI) recently released version 17.1, revealing 11,831 new edit pairs and 346 terminations, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a March 17 statement.

That's a large number of new edit pairs for the second quarter, which typically slackens after adding many new-code pairs in the first quarter.

"Most of the new edit pairs that impact general surgery practices involve bundling ancillary services that are typically part of the surgical procedure," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

Follow our experts' run down of the new edit pairs your practice faces to make sure you don't get caught in a denial-inducing bundling trap.

Include Standard Surgical Services

Medicare specifies that when you bill a surgical code, the procedure includes all intraoperative services that are usual and necessary parts of the surgery. That's why CCI 17.1 lists "standards of medical/surgical practice," as the reason for more than 2000 new code pairs.

Column 1: The following surgical procedures make up most of the column 1 codes for these new bundles:

Column 2: CCI 17.1 bundles the preceding surgeries with the following procedures that Medicare considers usual and necessary parts of surgery:

Watch nerve blocks, too: CCI 17.1 bundles the same column 1 codes with many nerve-block codes in the range 62310-64530, accounting for more than 1600 additional new edit pairs. CMS designates these "misuse of column 2 code with column 1 code," and assigns a "0" modifier indictor.

"That means you can never override these edit pairs that bundle many surgical procedures with somatic, autonomic or epidural nerve blocks," Bucknam says. "These edits may be targeting the use of blocks for post-op pain management by the surgeon, since Medicare bundles those services," she says.

Zero in on '0' Bundles

Nerve blocks aren't the only procedures that CCI 17.1 restricts to edit pairs with a "0" modifier indicator. You'll need to use extra caution with the following edit pairs because you can't override the bundles with modifier 59 (Distinct procedural service) under any circumstances.

Gastroplasty: You'll find 43842 bundled with moderate sedation codes 99148-99150 starting April 1.

Facet joint injections: CCI 17.1 bundles 64490-64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT] cervical or thoracic/lumbar or sacral; single level) into the following codes:

Mutually exclusive procedures: The following edit pairs join CCI 17.1 on the mutually exclusive table with a "0" modifier indicator:

Heed Thousands of Radiology Bundles

CCI 17.1 bundles 116 surgical procedures with more than 40 radiology codes, creating thousands of new edit pairs you need to know about.

Last quarter, CMS focused on adding more than 12,000 edit pairs for fluoroscopy and ultrasound guidance. This quarter, the latest CCI edits bundle many vascular procedures (in the range 34001-37215) with codes from the following groups:

"This large number of new edit pairs is another example of CCI's pattern of bundling services that are typically part of the surgical procedure -- radiological guidance, in this case," Bucknam notes.

Look for New Bone Excision Restrictions

CPT 2011 revised bone excision codes 27065-27067 (Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; ...) and 27070-27071 (Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, [craterization, saucerization] [e.g., osteomyelitis or bone abscess]; ...).

CCI 17.1 bundles many of these codes with each other, as well bundling some of them with the following services:

Inguinal Hernia/Spermatic Cord Repair Make 1 Procedure

Be careful when your surgeon performs a laparoscopic inguinal hernia repair with other procedures in the same region. CCI 17.1 bundles the service (49650-49651, Laparoscopy, surgical; repair ... inguinal hernia) with the following: