Part B Insider (Multispecialty) Coding Alert

Published on Mon Jan 09, 2012 PDF

New edition of bundling edits targets 2012 CPT® codes.

You may just be digging in to your 2012 CPT® book, but the Correct Coding Initiative (CCI) has already taken aim at some of the new codes by bundling them into existing codes effective Jan. 1.

The CCI released version 18.0 at the end of 2012, revealing 15,530 new active pairs and 6,197 code pair deletions, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in his analysis of the changes.

Many of the new code pair additions involve CPT® codes that debuted on Jan. 1, with CCI now halting payment if you report certain procedures together. For instance, you'll find skin repair codes 12001-12021 bundled into new skin substitute grafting codes 15271-15278, but in most cases, a modifier can separate the edit.

You cannot simply add a modifier (such as 59, Distinct procedural service) any time you want to separate a bundle like this--you'd have to justify it with the physician's documentation. "It would be a separate site, different session, different organ system, separate lesion, or separate injury for use of the 59 modifier to unbundle wound closure services from skin substitute procedures," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of Precision Auditing and Coding, and senior orthopaedic coder and auditor with The Coding Network. "Per the 59 modifier definition, these are the qualifications."

Compression application: Also new for 2012 and targeted by CCI 18.0 are three codes for application of a multi-layer compression system, as follows:

• 29582 -- Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed
• 29583 -- ...upper arm and forearm
• 29584 -- ...upper arm, forearm, hand, and fingers

You'll find these new codes bundled into scores of more comprehensive orthopedic procedures, including arthrocentesis code 20600 and many fracture care codes, among others.

To view the complete list of CCI edits, visit the CMS Web site at www.cms.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.