Part B Insider (Multispecialty) Coding Alert

Published on Wed May 07, 2003 PDF

You may think you know all the ins and outs of the 19,000 edits in the latest National Correct Coding Initiative, effective from Jan. 1 to March 31.

But you could be missing out on some crucial edits in your specialty or specialties you work with. And that could translate to payment denials and worse.

Version 9.0 of the NCCI has fewer total changes than other versions, but it hit anesthesiologists harder than usual. Now codes 33216, for insertion of a transvenous electrode, and 33207, for insertion or replacement of a permanent pacemaker with transvenous electrode, are mutually exclusive, says consultant Kelly Dennis with Perfect Office Solutions in Leesburg, FL. So are 63688, removal of implanted spinal neurostimulator, and 63685, incision and subcutaneous placement of spinal neurostimulator.

In all cases, the carrier will pay for whichever item has lower reimbursement, Dennis reminds anesthesiologists and surgeons.

Meanwhile, the NCCI now bundles anesthesia codes 01995 and 01996 with all new anesthesia codes. Also bundled are intravenous catheter codes like 36000 and 36005, venipuncture procedures 36400 through 36310 and 36420 through 36440, arterial procedure codes 36600 and 36640, nerolytic injection codes 62280 to 62282 and spinal injection codes 62284, 62310 and 62311, among others.

The changes to anesthesia edits also hit endocsopy coders hard. The new edition bundles all anesthesia but conscious sedation into endoscopy codes and bars coding for separate or "less extensive" procedures with comprehensive codes.

For example, NCCI bundles 64416 (injection of anesthetic agent, brachial plexus, continuous infusion by catheter) into most gastrointestinal codes. And you can't use general anesthesia codes such as 00520, 00740, 00810 and 00902 with the new endoscopy codes and new code 46706, for repair of anal fistula with fibrin glue.

"If they have bundled these codes, it is because they feel that the surgeon doing the endoscopy procedure is capable of IV sedation," says Barbara Johnson, with Loma Linda University Anesthesiology Medical Group in Loma Linda, CA.