Part B Insider (Multispecialty) Coding Alert

Published on Thu May 22, 2008 PDF

Check which modifier changes affect you

In addition to adding and deleting code bundles, CCI also uses its updates to announce whether you can append modifiers such as 59 (Distinct procedural service) to separate bundling edits. In Version 14.2, effective July 1, CCI changes some of those modifiers.

Cardiovascular surgery: In previous versions of CCI, edits bundled 32603 (Thoracoscopy, pericardial sac) into 33265 and 33266 (Maze procedure), and you could not separate the edits, even if you used modifier 59.

But the new edition of CCI will allow you to append a modifier to separately report the codes when necessary. These codes, however, -are not typically billed together,- says Terry Fletcher, CPC, CCS-P, CCS, CPC-EM, CPC-Cardio, CMSCS, CMC, a healthcare coding consultant in Laguna Beach, Calif.

Radiology: CCI made the opposite change to the modifier for the edits bundling A4641 (Radiopharmaceutical, diagnostic, not otherwise classified) into 78811-78816 (PET imaging). Whereas you used to be able to separate these bundles by using a modifier, CCI 14.2 will no longer allow that effective July 1. Instead, you-ll have no way to separately report these codes.

This edit is appropriate, says Kim French, CIC, director of interventional coding and reimbursement at Crouse Radiology Associates in Syracuse, N.Y.

-Practices should not be using A4641 to report the pharmaceutical for a PET scan and also would not be performing any other nuclear study on the same day as a PET, so they would have no other reason to report it,- French says. -The only approved PET pharmaceuticals are Rubidium RB-82 (A9555), Ammonia N-13 (A9526), and Fluorodeoxyglucose F-18 FDG (A9552).-