Pediatric Coding Alert

Plus: 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 pulse oximetry (94760-94762) bundled into the new car seat testing codes 94780-94781, but in most cases, a modifier can separate the edit when necessary.

Keep in mind: 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 that shows the distinct nature of the service, such as a separate site or session, says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of Precision Auditing and Coding.

Say Goodbye to Modifier 59 for This Bundle

Not all of the CCI changes involve new bundles--some CCI changes dictate whether you can use a modifier to separate a particular edit. For instance, you'll find that the indicator has changed from a "1" (meaning a coder could separate the bundle with a modifier) to "0" (meaning the edit cannot be separated under any circumstances) for the edits bundling subsequent hospital care codes 99231-99233 into the initial daily inpatient neonatal/pediatric critical care codes 99468, 99471 and 99475.

Example: Suppose the pediatrician is doing rounds on an established infant inpatient. He evaluates a patient and determines she requires critical care. In this instance, he should only report the critical care code and not the subsequent inpatient E/M for that visit.

With a '0' edit, you would report only the more extensive service, which would be the neonatal/pediatric critical care service, Stumpf says. "This would mimic the same type of situation as an ER visit resulting in admission - the admission is the definitive, reportable service. The ER visit and the admission cannot be reported for the same encounter."

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 limb injury procedures, including 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.

Some CCI Changes Stem From Policy Manual Rewrite

Although coders mostly think about lists of coding bundles when we discuss the Correct Coding Initiative, there is another side to national bundling rules--the National Correct Coding Initiative Policy Manual. Thanks to a January 2012 update, you should peruse the manual to determine what's changed this year.

CMS Discusses MUE Value of '0'

Medically unlikely edits (MUEs) are still relatively new, so many coders might scratch their heads at some aspects of these edits--particularly when a service has a limit of '0.' If you're wondering why a service would be listed at all if the limit is zero, the 2012 update to the manual finally offers some answers, Stumpf points out.

"The rationale for such values include but are not limited to: discontinued manufacture of drug, non-FDA approved compounded drug, practitioner MUE values for oral anti-neoplastic, oral anti-emetic, and oral immune suppressive," the manual notes.

In other words, CMS wants the code listed in the CCI edits, but wants to remind coders that it won't be reimbursed.

Keep These Tips in Mind When Injecting Epinephrine

If a patient presents to your office with an allergic reaction and you administer an epinephrine injection to treat the patient, you probably turn to J0171 (Injection, adrenalin, epinephrine, 0.1 mg), which replaced deleted HCPCS code J0170 in 2011. But in these cases, it's important to keep the number of units you should report in mind.

"HCPCS code J0170 was often reported incorrectly," the Policy Manual notes. "A 1 ml ampule of adrenalin/epinephrine contains 1.0 mg of adrenalin/epinephrine in a 1:1,000 solution. However, a 10 ml prefilled syringe with a 1:10,000 solution of adrenalin/epinephrine also contains only 1.0 mg of adrenalin/epinephrine. Thus a physician must recognize that 10 units of service for HCPCS code J0171 corresponds to a 1 ml ampule or 10 ml of a prefilled syringe (1:10,000 (0.1 mg/ml) solution)," it clarifies.

Consider Imaging Bundled Into These Chest Procedures

When it comes to emergency endotracheal intubation procedures (31500), and chest tube insertions (32422, 32550, 32551), pediatricians are accustomed to performing a post-procedural x-ray to determine that the tubes are in the correct position. However, because CMS considers that imaging to be typically associated with the procedure, the CCI has included the imaging payment into the RVUs for the insertions.

"A chest radiologic examination CPT code (e.g., 71010, 71020) should not be reported separately for this radiologic examination," the manual says regarding these post-procedure x-rays.

To read the complete updated Policy Manual, visit www.cms.gov/NationalCorrectCodInitEd.