Part B Insider (Multispecialty) Coding Alert

Published on Sat Sep 23, 2006 PDF

Prolonged services, moderate sedation edits also modifier-proof

A new set of 36 mutually exclusive edits guarantees that you won't be able to bill any of the new nursing facility evaluation & management codes on the same day as any other code from that series.

All of the codes from 99304-99316 will become mutually exclusive with most of the other codes from the Inpatient Nursing Facility Care section, which was introduced in 2006. Also, every code from 99305 and higher is mutually exclusive with every lower code.

Previously, the inpatient nursing facility E/M codes were components of each other, not mutually exclusive, and you could use a modifier to override those edits. But these new edits have a -0- in the modifier column, meaning you can't append a modifier and overcome them.

- Prolonged services codes 99354-99357 will become components of nursing facility discharge day management codes 99315-99316. You won't be able to use a modifier to override those edits.

- Moderate sedation codes 99413-99144 become components of therapeutic radiology codes 77280-77300, 77326-77328, 77336-77370 and 77781-77784. You can't use a modifier to override these edits, either.

- Electroencephalogram (EEG) analysis code 95957 becomes a component of EEG codes 95827-95829 and half a dozen special EEG test codes between 95950 and 95966. You can't use any modifier to override those edits.

- 32100 (Thoracotomy, major; with exploration and biopsy) becomes a component of 232 codes, including 10 musculoskeletal surgery codes, a dozen respiratory surgery codes, 171 cardiovascular system surgery codes, 11 hemic and lymphatic system surgery codes, 24 esophagus surgery codes, and four intraspinal lesion excision codes. You can use a modifier to override these edits.

- A baker's dozen codes will become components of 97755 (Assistive technology assessment [e.g., to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility], direct one-on-one contact by provider, with written report, each 15 minutes), including ultrasound code 97035, several codes from the therapeutic procedures section, and orthotic/prosthetic training codes 97760-97761. You can override these edits with a modifier, where appropriate.

- Cystourethroscopy code 52007 becomes a component of every cystourethroscopy code from 52320 to 52355, except for 52332. You can't override those edits.

- Lesion-shaving code 11300 and three other codes from the lesion-shaving section become mutually exclusive with lesion destruction code 17000. You can use a modifier on these edits.