Part B Insider (Multispecialty) Coding Alert

Published on Fri Jun 11, 2004 PDF

CMS removes burdensome edits from dozens of codes

When the Centers for Medicare & Medicaid Services introduced a number of new end stage renal disease codes for 2004 (G0308-G0327), providers rejoiced. When the Correct Coding Initiative 10.0 bundled dozens of other codes with these codes, providers moaned. Now, relief is on the horizon.

The new ESRD codes replaced 90918-90921, which became invalid for Medicare. The G-codes enabled physicians to bill for ESRD care based on the number of visits provided per month and the patient's age. (For each age, the codes include four physician visits per month, two to three per month, one per month and none per month, respectively).

Last January, the CCI Edits bundled virtually every evaluation and management code with G0308-G0327 (See PBI, Vol. 4, No. 35). Now CCI has relented and deleted those edits, making it easier to bill ESRD care and E/M visits on the same dates.

Also, hemodialysis codes 90935-90937 and miscellaneous dialysis codes 90945-90947 will no longer be bundled with G0308-G0327 starting in July.

Separately, 95004 (Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, specify number of tests) will no longer be a component of 95010 (...with drugs, biologicals or venoms, immediate type reaction, specify number of tests). And 73560 (Radiologic examination, knee; one or two views) will no longer be a component of 73565 (...both knees, standing, anteroposterior).

Also, 33416 (Ventriculomyotomy (-myectomy) for idiopathic hyper-trophic subaortic stenosis) will no longer be a component of 33400 (Valvuloplasty, aortic valve; open, with cardiopulmonary bypass).

CPT code 57280 (Colpopexy, abdominal approach) will no longer be a component of hysterectomy code 58152 (...with colpourethro-cystopexy). Finally, bladder catheter insertion codes 51701-51702 will no longer be components of 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging).

The latest version of the CCI, Version 10.2, removes 1,702 previously troublesome bundling edits from providers'lives. But it also adds 2,939 new bundling edits and 378 new mutually exclusive edits, creating a host of new headaches for providers.

Read more about the new edits inside.