Part B Insider (Multispecialty) Coding Alert

Published on Fri Nov 18, 2005 PDF

New nursing home, domiciliary care codes hit with hundreds of edits

Radiologists will find life especially difficult once the new Correct Coding Initiative edits take effect in January.

Evaluation and management CPT 99201 -99239 will each become components of dozens of codes, including many  radiology codes.

You won't be able to use a modifier to override edits bundling new abortion anesthesia codes 01965-01966 and radiology codes 77300-77370, 77421-77423 and 77520-77525 with all of those E/M codes. You also won't be able to use a modifier to override edits bundling intensive care code 99300 with most other E/M codes.

Also, a number of radiology codes will be bundled with emergency department services codes 99281-99285 and critical care codes 99289-99299. A large number of radiology codes will become components of those codes without any recourse to a modifier: 77261-77295, 77300-77370, 77416-77418 and 77422-77423.

CPT 2006 introduced a number of new E/M codes, including subsequent intensive care code 99300, nursing facility care codes 99304- 99318, and domiciliary, rest home or custodial care services codes 99324-99340. Now CCI 12.0 makes these new E/M codes components of dozens of other codes.

Example: Over 250 anesthesia codes become components of these new E/M codes, and you won't be able to use a modifier to override those edits. And you won't be able to use a modifier to override edits bundling those codes with neutron beam treatment codes 77422-77423, brachytherapy codes 77750-77790, several psych E/M codes, or dialysis codes 90935-90937 and 90945-90947.

Good news: You will be able to use a modifier to override edits bundling chemotherapy codes 96401-96409, 96413, 96416, 96440-96522 and 96542 with pretty much every new and old E/M code. You'll be able to override edits bundling chiropractic codes 98940-98942 with all of the E/M codes as well.

Also, CCI 12.0 bundles osteopathic manipulative treatment codes 98925-98929 with the new intensive care, nursing facility and domiciliary E/M codes, but you can use a modifier to override those edits.

For 2006, CMS also introduced two new codes for intravenous infusion of therapeutic agents as part of the hospital outpatient prospective payment system, C8950 and C8951. These each become components of around 5,400 other codes, but you can use a modifier to override almost all of these edits.