Part B Insider (Multispecialty) Coding Alert

Published on Tue Aug 16, 2011 PDF

Plus: CMS also aims to stop you from billing AWVs with IPPEs.

Your surgeon was "in the area" so he decided to laparoscopically remove a patient's appendix while he was there? You won't collect for that anymore, thanks to new edits included in the Correct Coding Initiative.

CCI version 17.3, which takes effect Oct. 1, offers 1,380 new edit pairs and 835 terminated bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC. As was the case with the previous CCI edition, the majority of edits impact the codes from the musculoskeletal code range (20000-29999), but bundles did occur to codes throughout the CPT^® manual.

You'll find 44970 (Laparoscopy, surgical, appendectomy) bundled into most surgical codes involving the pelvic region, from ruptured spleen repair code 38115 to ovarian resection code 58950, and beyond. What's more, the appendectomy edits cannot be undone using a modifier (such as 59, Distinct procedural service) under any circumstances, thanks to a "0" indicator on the nearly 500 new code pair bundles.

Likewise, CCI now bundles the surgical appendectomy codes 44950-44960 into many other pelvic surgeries (which also cannot be overridden with a modifier), but the edits are not as vast as those affecting laparoscopic appendectomies.

AWV, IPPE Don't Go Hand-in-Hand

A new round of CCI edits wouldn't be complete without taking further aim at the new annual wellness visit (AWV) codes G0438-G0439--but these edits shouldn't hurt your wallet. This time around, CCI bundles both of the AWV codes into G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment). As most practices are aware, you should not be reporting an AWV during the same visit as the "Welcome to Medicare" exam, also called an IPPE, so these edits come down to common sense.

For more on CCI edits and to find which ones impact your practice, visit the CMS Web site at www.cms.gov/nationalcorrectcodinited/ncciep/list.asp.