Pediatric Coding Alert

CCI 14.1 forces you to get a handle on separate, significant serviceThe next time a patient requires hydration therapy, therapeutic injection, catheterization or a chest x-ray following an E/M service, your procedure pay may depend on modifier 25, thanks to a new batch of edits.Keep Coding Modifier 25 ServiceThe latest version of the Correct Coding Initiative (CCI), effective April 1, extends the intravenous infusion (90760, 90765) and therapeutic, prophylactic or diagnostic injection (90772-90774) E/M bundles to the facility setting.CCI version 14.1 includes intravenous infusion (90760, 90765) and therapeutic, prophylactic or diagnostic injections (90772-90774) in all facility and home E/M services (99217-99350). CCI 12.0 had made 90760, 90765 and 90772-90774 components of office-based E/M services.CMS bases the injection-inpatient/observation edits on "standards of medical/surgical practice" and allows a modifier breaker. The edit simply codifies a CPT guideline. The Hydration, Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy) introductory notes state, "If a significant, separately identifiable Evaluation and Management service is performed, the appropriate E/M service code should be reported using modifier 25 in addition to 90760-90779," says Denae M. Merrill, CPC-E/M, owner of Merrill Medical Management in Saginaw, Mich.Relief: The new edit doesn't change much, Merrill says. "These services have been bundled together since the creation of 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular)."Code Service Outside the Procedure's Included E/MIn fact, the bundles bring CCI in line with CPT. Version 7.3 of CCI said that all codes with "XXX" global periods, such as 90772, include a minor related E/M service, says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J. Therefore, practices couldn't bill those codes with an E/M service unless they could justify using modifier 25. But each individual carrier was able to decide whether to implement that rule."Now that the CCI is bundling some of those codes (such as 90760, Intravenous infusion, hydration; initial, 31 minutes to 1 hour) with E/M services, they're not leaving it to the carriers anymore," Cobuzzi says.Extend E/M Bundle to Caths, X-RaysCCI 14.1 similarly includes catheterizations (51701-51702, 0 global days) and chest x-rays (71010-71020, XXX global days) in many of the same facility E/M services. Under "CPT Manual and CMS coding manual instructions," CCI creates these bundles:Check if Service Meets Dual DefinitionYou know you can't just willy-nilly append modifier 25 to the E/M service. The pediatrician must perform and document an E/M service that is significant and separately identifiable from the minor evaluation included in the hydration therapy or therapeutic injection.Key: To avoid overlooking opportunities to correctly capture a service in addition to the minor procedure, you have to spot E/Ms that qualify as significant and separate. Merrill suggests [...]