Version 8.0 of the Correct Coding Initiative (CCI) edits went into effect Jan. 1, 2002, and remains active until March 31, 2002. The changes primarily involve microbiology services that are now mutually exclusive code pairs, as well as a list of pathology services that are bundled with a pathology consultation.
"Billing personnel need to be aware of these new edit pairs, as well as correct modifier usage, to avoid payment denials when these services are legitimately performed together for the same patient on the same day," says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, laboratory coding and compliance consultants in Longwood, Fla.
CCI Identifies Inappropriate Coding
"The edit pairs represent services that are bundled (components of a more comprehensive service) or would not ordinarily be performed together for the same patient on the same day (mutually exclusive services)," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the National Advisory Board of the American Academy of Professional Coders, and president of Physician Coding and Compliance Consulting in Virginia. Medicare will not reimburse both services when reported together.
However, if the two services of a code pair are carried out as distinct and independent services that are medically necessary, Medicare may reimburse with the appropriate modifier. To indicate that codes represent separate services as opposed to unbundling of a single service, append modifier -59 (distinct procedural service) to override the edit.
Every code pair is assigned a "modifier indicator" of either "1," which means a modifier can be used with the pair, or "0," which means a modifier cannot be used. Practices should ensure that they do not indiscriminately override CCI edit pairs . When edit pairs are overridden, appropriate documentation must exist in the medical record to justify the claim of "distinct procedural service."
Microbiology Screening Codes
Nearly a third of the edits are mutually exclusive pairs that preclude reporting a screening culture with other culturing techniques. The two screening culture codes are 87081 (culture, presumptive, pathogenic organisms, screening only) and 87084 (... with colony estimation from density chart). The edits preclude reporting these two codes together or reporting either code with the following culture services:
87040 culture, bacterial; blood, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate)
87045 ... feces, with isolation and preliminary examination (e.g., KIA, LIA), Salmonella and Shigella species
87046 ... stool, additional pathogens, isolation and preliminary examination (e.g., Campylobacter, Yersinia, Vibrio, E. coli 0157), each plate
87070 ... any other source except urine, blood or stool, with isolation and presumptive identification of isolates
