Part B Insider (Multispecialty) Coding Alert

Published on Sat Mar 05, 2005 PDF

Urinary bladder residual study code hit with dozens of edits

If you've been using the new infusion codes that Medicare introduced for 2005 with any other codes, then you'll have some adjustments to make when the new batch of National Correct Coding Initiative (NCCI) edits takes effect April 1.

NCCI 11.1 bundles new infusion code G0354 (Each additional sequential infusion push) into 752 other codes. These include:
 

 several other new infusion codes,
 

 endoscopy codes 43200-43272, 44360-44397, 45300-45387 and 46600-46615,
 

 injection codes 62310-62319, 64400-64483 and 64505-65530, and
 

 224 codes from CPT's diagnostic radiology section.

Also, infusion codes G0351-G0354 each become components of 37 codes from CPT's medicine section, including dialysis codes 90935-90947 and 90997, gastroenterology codes 91011 and 91052, ophthalmological codes 92018-92019 and 92230-92240, range-of-motion testing codes 95857-95858, several cardiology codes, and several neurology testing codes.

Separately, 31 codes will become components of islet cell transplant codes G0341-G0343. These include infusion codes G0345 and G0347. Also, G0342 will become a component of G0343, and G0341 will become a component of both G0342 and G0343.

As of April 1, G0341-G0343 also will have the following components: four radiology codes, three vascular injection codes, transcatheter therapy code 37202, tube placement code 43752, five intestinal system surgery codes, hernia repair code 49570, laparotomy codes 49000-49010 and 49255, nerve block injection codes 64415-64417 and 64450-64475 and spine injection codes 62318-62319.

More new NCCI edits:

 Thoracentesis code 32002 and thoracostomy code 32020 both will become components of new Category III codes 0048T and 0050T-0053T. Also components of 0048T and 0050T-0053T are chest exploration code 35820 and mediastinotomy code 39010.
 

 Eleven codes become components of breast tumor destruction/ reduction code 0061T, including injection codes 62318-62319, anesthesia codes 64415-64418 and 64450-64475.
 

 Prolonged services codes 99354-99357 become components of new radiation oncology codes G0338-G0340.
 

 Code 78730 (Urinary bladder residual study) will become a component of 79 evaluation and management codes, plus dozens of urinary system surgery codes, including 52000-52240 and 52260-52318, nine radiology codes, echocardiography codes 93307-93350, arterial study code 93880 and extremity venous studies codes 93965-93971. You can't use a modifier to override any of these edits - except for the ones involving E/M codes.
 

 Endoscopy codes 43200-43234 will become components of 43257 (Upper gastrointestinal endoscopy including esophagus; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease). You won't be able to use a modifier to override these edits.
 

 Intra-arterial injection code 90783 is becoming a component of 22 codes, including cardiovascular therapy codes 92986-92993 and cardiac catheterization codes 93501-93533.
 

 Debridement codes 11000 and 11040-11042 will all become components of four bypass graft codes (35510, 35512, 35522 and 35525).
 

 Screening colonoscopy codes G0105 and G0121 will become mutually exclusive with endoscopy codes 45378-45387. You won't be able to use a modifier to override these edits.

Note These Deleted Edits

Cholecystectomy code 47600 is no longer a component of 48150 (Pancreatectomy, proximal subtotal with near-total duodenectomy, choledochoenterostomy and duodenojejunostomy [pylorus-sparing, Whipple-type procedure]; with pancreatojejunostomy).

NCCI 11.1 also deletes edits which had made wound repair code 12042 mutually exclusive with 12052-12053.