Orthopedic Coding Alert

Tip: Check for procedures like pacing electrode and central venous catheter insertion,  nerve conduction, and evoked potential studies.

The latest Correct Coding Initiative (CCI) edits – version 19.1, effective April 1, 2013 – alter your epidural procedure reporting and also your coding for some chemodenervation codes.

Don’t Miss Epidural Reporting Changes

Edits involving modifier changes aren’t always big news, but the ones for CCI 19.1 are for epidural procedures, both diagnostic and therapeutic. Almost 300 new edits are in effect for epidural procedures, including two that you may often get to report:

·         62310 – Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic

·         62311 – … lumbar or sacral (caudal).

“The modifier changes proved to be a bit of a bummer, as all of the edits affected went from a value of ‘1’ (you may use a modifier, where appropriate) to a value of ‘0’ (you can never use a modifier, even if appropriate),” says Frank Cohen, principal and senior analyst for The Frank Cohen Group in Florida.

Affected procedures range from pacing electrode insertion to central venous catheter insertion. Check the full list of CCI edits for a complete look at procedures.

Silver lining: The rationale for edits is “Anesthesia service included in surgical procedure.” The edits, however, only apply when the same physician completes the procedure and administers the epidural. If you code separately for a pain management provider to administer the epidural, you can bill for his service.

Check Whether a Bypass Is Possible in Chemodenervation Codes

Some of the edits involving chemodenervation codes can be “bypassed” by appending a modifier in order to report both procedure codes. You can’t slip past the edit for other pairs, however, so pay attention to the assigned modifier indicators.

No bypass possible: Chemodenervation codes 64612 (Chemodenervation of muscle[s]; muscles innervated by facial nerve, unilateral (e.g., blepharospasm, hemifacial spasm), 64613 (Chemodenervation of muscle[s]; neck muscle[s] [e.g., for spasmodic torticollis, spasmodic dysphonia]) and 64614 (…extremity and/or trunk muscle[s] [e.g., for dystonia, cerebral palsy, multiple sclerosis]) are now bundled with the new code 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic migraine]). All three of these CCI edits list 64615 as the Column 1 or comprehensive code, meaning you should report it instead of the other procedure if the physician completes both services during the same encounter. The edits carry a modifier indicator of “0,” so you cannot append a modifier in hopes of breaking the edit and getting paid for both procedures. The reasoning for the “0” modifier is CPT^® manual or CMS manual coding instructions.” Remember that prior to January 1, 2013, the provider would typically report multiple chemodenervation codes for treatment of chronic migraine. Beginning in 2013, the provider should only report new code 64615. The new edits reinforce that coding directive.

Bypass option: Approximately 20 other edits involving 64615 are classified with modifier indicator “1,” which means you can sometimes append a modifier to break the edit and report both services. The most appropriate modifier will depend on the situation, but coders often turn to modifier 59 (Distinct procedural service).

Note that nerve conduction studies and evoked potential studies are among other codes that share an edit with 64615. Some of the edits in these pairs that you might be able to unbundle and report with 64615 include:

·         92585 – Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive

·         95822 – Electroencephalogram (EEG); recording in coma or sleep only

·         95907-95913 – Nerve conduction studies …

·         95925 – Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs 

·         95928 – Central motor evoked potential study (transcranial motor stimulation); upper limbs 

·         95938 – … in upper and lower limbs.