Medicare Compliance & Reimbursement

You can't use a modifier to override nursing facility edits anymore.

Correct Coding Initiative (CCI) version 13.0 may not sound like your lucky number--but it does bring some good news.

January's update to the CCI deletes nearly twice as many edit pairs as it adds, according to CCI analyst Frank Cohen with CPA Health in Clearwater, FL. It adds just 9,610 edit pairs, including 8,772 non-mutually exclusive and 839 mutually exclusive. But it deletes nearly 18,000 edit pairs.

Some of the deletions involve codes that have expired, including some Category III codes. Also, the Centers for Medicare & Medicaid Services (CMS) has deleted drug administration codes C8950 and C8952, which were replaced with 90765 and 90774 respectively. The 5,422 edits governing C8950 and 5,415 edits governing C8952 were deleted, but new edits for 90765 and 90774 don't seem to have taken their place.

Similarly, 1,765 edits for deleted anesthesia injection code 01995 were deleted.

Appeal now: Some deletions were retroactive to 2004 or January 2006, including edits with unlisted arthroscopy code 29999 and abortion code 59897 in the "Column 1" position, says Cohen. This means that if you received any denials for another code alongside these codes in the past year, you have a good chance of overturning them if you appeal.

Watch out: You may miss these deletions if your software looks only for edits deleted as of January 1, Cohen warns.

CCI 13.0 also deletes edits that bundled 14 other evaluation & management (E/M) codes into initial nursing facility visit codes 99304-99306. Unfortunately, it also changes the modifier status on edits that bundled another 49 E/M codes into 99304-99306. Previously, you could use a modifier to bill those E/M codes with 99304-99306, but now you can't.

Also, right now you can use a modifier to override edits that bundle anoscopy code 46600 into 43 other codes from the anal surgery section. But starting in January, no modifier will be allowed with those edits. And you can no longer use a modifier to bill continuous pressure ventilation codes 94660-94662 with critical care codes 99289-99290.