Part B Insider (Multispecialty) Coding Alert

Published on Sun Jun 11, 2006 PDF

Hospital day discharge management and critical care now billable together

If your facility bills for magnetic resonance angiography (MRA) codes C8900-C8920 under the outpatient prospective payment system, then you could face more billing challenges soon.

The Correct Coding Initiative version 12.2 makes a dozen other codes components of C8900-C8920, including catheterization code 36000, venipuncture code 36410, radiology codes 76000, 76003, 76350, 76376-76377, 76492 and 76986, and injection codes 90772-90775. You can use a modifier to override all of these edits except the ones governing 76350 and 76376-76377. The edits also bundle some of the MRA codes with each other.

In other new CCI changes:

• 73 E/M codes become components of initial nursing facility care codes 99304-99306. You can use a modifier to override almost all of these edits except those governing some neonatal intensive care codes and work/disability exam codes 99455-99456. Also, newborn infant history and exam code 99435 becomes a component of 99304, and you can’t override that edit with a modifier.

• Most of the cholecystectomy codes between 47562-47620 become components of hepatectomy codes 47120-47130. Also, 47562, 47564 and 47570 become components of 47140-47142, and 47610 becomes a component of 47141-47142. You can’t use a modifier to override any of these edits. But you can use a modifier to override edits that make 47120 a component of colectomy codes 44150 and 44160 and enterostomy code 44625.

• Also, you can’t use a modifier to override edits that make laparoscopy code 49320 a component of cholecystecomy codes 47600 and 47610, plus cannula/catheter insertion code 49421. Also immune to modifiers is an edit that makes 47563 and 47564 mutually exclusive.

• Nor can you use a modifier to override edits that make pacing cardioverter/defibrillator analysis code 93741 a component of 93742, or 93743 a component of 93744.

• You can’t bill for transcatheter permanent occlusion or embolization codes 61624-61626 along with transcatheter stent placement codes 37205 or 76960, unless you use a modifier.

• Radiology codes 77321-77326 become components of stereotactic radiosurgery code G0173, but you can override that edit with a modifier.

• CCI 12.2 also deletes a modifier-proof edit that made critical care codes 99291-99292 components of hospital discharge day management code 99239. Now, if a patient has an emergency requiring 30 minutes or more of critical care on the same day as his or her discharge, you can bill for both services.

• And CCI 12.2 deletes an edit that made colectomy code 44145 mutually exclusive with enterectomy code 44120.