Oncology & Hematology Coding Alert

Leave 76375 Off Your Tumor Imaging Claims

Published on Mon Oct 10, 2005

And for brachytherapy, NCCI gives with one hand and takes with the other

Here's the short list of the National Correct Coding Initiative edits that affect you most.

For these nonmutually exclusive edits, if you report the bundled pairs together, you-ll only be paid for the column 1 code.

Find the full listing, effective Oct.1, on the CMS Web site www.cms.hhs.gov/physicians/cciedits/.

NCCI 11.3 Nonmutually Exclusive Edits--Deleted

Note: These edits are deleted as of Oct. 1. Radiation Treatment Delivery Edits:

- Special dermatological procedures codes 96900, 96910-96913 are no longer bundled into radiation treatment delivery codes 77402-77416

- Special dermatological procedures codes 96900, 96910, 96913 are no longer bundled into radiation treatment delivery code 77417

- Radiation treatment delivery codes 77401-77416 are no longer bundled into photodynamic code 96567   Clinical Brachytherapy Edits:

- E/M codes 99241, 99255, 99271-99275, 99354-99355, 99360 are no longer bundled into clinical brachytherapy code 77776 NCCI 11.3 Nonmutually Exclusive Edits--Added

Note: An asterisk (*) beside the edit represents a modifier indicator of -1,- meaning that you override the edit when appropriate.

No asterisk represents a modifier indicator of -0.- A -0- means that you can't break the bundle.

Remember: Modifier 59 may override an edit, but that doesn't mean reporting both codes was appropriate. Clinical Brachytherapy Edits:

- E/M codes 99239, 99298-99350, 99431-99440, 99455-99456 are bundled into clinical brachytherapy codes 77750-77763, 77777-77790

- E/M codes 99299, 99347 are bundled into clinical brachytherapy code 77776   Nuclear Medicine Edits:

- 3D reconstruction code 76375 is bundled into radiopharmaceutical localization codes 78800-78807*

- Injection code G0351 is bundled into radiopharmaceutical localization codes 78800-78807*

- 3D reconstruction code 76375 is bundled into tumor imaging codes 78811-78816*

- Injection code G0351 is bundled into radiopharmaceutical therapy codes 79200-79440* Note: For more information on how the latest round of NCCI edits will affect you, see -E/M With Brachytherapy? NCCI Says, -Don't Even Think About   It- - and -Cut Through Red Tape Before Coding CT With PET/CT- earlier in this issue.

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