Part B Insider (Multispecialty) Coding Alert

Published on Sat Nov 20, 2010 PDF

New edition of bundling edits target 2011 codes.

You may just be digging in to your 2011 CPT book, but the Correct Coding Initiative (CCI) has already taken aim at some of the new codes by bundling them into existing codes.

The CCI released version 17.0 earlier this week, revealing 19,822 new active pairs and 9,778 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in a Dec. 14 announcement.

Many of the new code pair additions involve CPT codes that debut on Jan. 1, with CCI getting ready to halt payment if you report certain procedures together. For instance, you'll find spinal injection codes 62310-62319 bundled into new code 29914 (Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion), and no modifier can separate these edits.

CCI Has Good News and Bad News on the Modifier Front

Not all news coming out of the new edition of CCI is bad. Effective Jan. 1, you'll be able to use a modifier (such as 59, Distinct procedural service) to separate the edit bundling wound care management codes 97597-97602 into the newlyrevised debridement codes 11042-11044. In the past, if your practitioner performed both procedures on the same date of service, you could not collect for both no matter what, but now you will be able to if your documentation demonstrates the separate and distinct nature of the services.

Unfortunately, not all news is good news when it comes to modifier changes in CCI 17.0. Whereas in the past you were permitted to use a modifier to separate the edits bundling wearable telemetry device codes 93228-93229 into wearable ECG rhythm derived monitoring codes 99224-93227, the new version of CCI puts a stop to that, adding a "0" indicator to these code pairs and thus prohibiting MACs from ever paying you for both performed on the same date for the same patient.

The majority of the new CCI edits take effect on Jan. 1, although some were published with retroactive dates. For more information on CCI edits, visit www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.