General Surgery Coding Alert

Most of Correct Coding Initiative (CCI) 16.0's extensive list of terminated edit pairs involves deleted codes that you won't be using any more. But beware of changing your coding for deleted edits pairs involving existing codes -- because some of these bundles came back in a different form.

CCI 16.0 includes numerous terminated code pairs that affect a long list of general surgery codes. But don't let that worry you. "The deletions primarily involve codes that were either deleted from CPT 2010 or the consultation codes that are no longer covered by Medicare," says Marvel Hammer, RN, CPC, CCS-P, PCS, ACSPM, CHCO, owner of MJH Consulting in Denver.

The inactivated edits apply to consultation codes 99241-99245 (Office consultation for a new or established patient...) and 99251-99255 (Inpatient consultation for a new or established patient...) that you should no longer bill to Medicare anyway.

Tip: When you look at the latest CCI edit list on the Medicare Web site at www.cms.hhs.gov/NationalCorrectCodInitEd, you'll find the deletion date for edit pairs in column E.

CCI 16.0 deletes over 110 code pairs that bundle 11010-11012 (Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s);...) with many of the revised tumor excision/resection codes in the range 21015-28175.

Don't look at the deleted edits and think you can gain payment for a debridement and excision at the same site and session. CCI 16.0 adds back mutually exclusive edit pairs for each of the deleted pairs -- only this time the 11010-11012 are the column 2 codes.

Do this: If you meet the requirements to code a debridement and excision together, such as separate body sites, you can use modifier 59 (Distinct procedural service) to override the new edit pairs (which replace the deleted bundles).

Bottom line: "You should never submit these codes together without a modifier, no matter which code is in which column," says Marcella Bucknam, CPC, CCSP, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program.