CCI EDITS:
Avoid Spinal Surgery Denials By Heading CCI Changes
Published on Mon Aug 27, 2007
No modifier will overcome 13.3's hundreds of new surgery edits
Bad news: You can pretty much give up on billing some rectum and anus surgery codes with a number of other surgery codes, under any circumstances.
The Correct Coding Initiative version 13.3 creates a number of bundles involving:
• rectum manipulation codes 45900-45915;
• 46040 (I&D of ischiorectal and/or perirectal submuscosal abscess, transanal, under anesthesia) and 46080 (Sphincterectomy, anal, division of sphincter); and
• anal excision codes 46200-46220.
CCI gives these edits a modifier indicator of "0," so you cannot use a modifier to override the 589 edits that bundle those codes into many others.
For example: Codes 45900-45915 will be components of rectal surgery codes 45000-45190 come Oct. 1. Also, 46040, 46080 and 46200-46220 will become components of almost all of the codes from 45000-45190.
CPT codes 46040, 46080 and 46200-46211 also will become components of most of the anal surgery codes in 46500-46947. Codes 45900-45915 will be components of 46040 and hemorrhoid surgery code 46320.
Also, 46040, 46080 and 46210-46211 all become components of rectal endoscopy codes 45300-45392. Meanwhile, 46040 and 46210 become components of 45500-45825. And 46080 and 46211-46220 also become components of some of those codes. Code 46220 becomes a component of anorectal exam code 45990.
Another set of edits makes it impossible to bill many of the anal surgery codes in 46020-46083 with the other codes in that same series. And 46210 becomes a component of most of those anal surgery codes, plus most of the hemorrhoid surgery codes in 46221-46285.
Also, you can't bill for any one of those rectum manipulation codes (45900-45915) with any of the others. For example, 45905-45915 are components of 45900. Bottom line: Rectal manipulation codes 45900-45915, anal surgery codes 46040 and 46080 and anal excision codes 46200-46220 will become impossible in October. You won't be able to bill these codes with many commonly performed procedures--even with a modifier.
Don't Look For Closure Payments
Watch out: CPT codes 12001-12007, for simple repair of superficial wounds, become components of four dozen codes each from the musculoskeletal system section in the latest CCI update.
In a nutshell: Thanks to CCI, you probably can't bill for one of those superficial wound repair codes at the same session as a deep excision, a tissue graft, a radical tumor resection, a deep incision and drainage (I&D), a radical resection, a spine surgery or a lesion excision.
Layered wound closure codes 12031-12037 and 12041-12047 will also become components of most of the same surgical codes.
Complex wound repair codes 13100-13132 (except for the add-on codes) are also slated to become components of a couple of dozen surgical codes.
Similarly, superficial facial wound repair codes 12011-12018 became components of a number of surgical codes, including several facial fracture care codes. [...]
