Part B Insider (Multispecialty) Coding Alert

Published on Mon Jan 12, 2009 PDF

Several modifier changes will alter the way you code psychotherapy, conscious sedation, and more.

In addition to Correct Coding Initiative (CCI) code pair additions that CCI Version 15.0 dished out effective Jan. 1, your Medicare claims will also be affected by alterations that will change whether you can append a modifier to separate a code pair.

The good news: In the past, you couldn't use a modifier to separate the edit bundling 95861(Needle electromyography; 2 extremities with or without related paraspinal areas) into 95810 (Polysomnogra-phy; sleep staging with 4 or more additional parameters of sleep, attended by a technologist). Now, however, CCI will allow you to separate it with a modifier.

The bad news: Most of the modifier changes in version 15.0 work the other way around. You can no longer use a modifier to separate 87 of the bundles that you previously could separate with a modifier. For instance, you can't separate the edits bundling 90865 (Narcosyn-thesis) into codes from the 90807-90829 series (Psychotherapy).

Plus: You'll also be out of luck if you try to report conscious sedation codes 99143-99144 with any of the codes from the 49440-49442 series (tube placement). Medicare payers will deny the conscious sedation charge, and no modifier can separate the bundles.

"With each edition of CCI comes more codes that are forbidden to report with conscious sedation," says Aran Hicks, billing consultant for six practices in Raleigh, N.C.