Primary Care Coding Alert

Prepare for edits to strapping, nebulizer services -- and more Find out when and how to break payment bundles for I&D, continuous inhalation treatment, and home apnea monitoring with these insider secrets. 1. Include Applying Dressing in I&D If your FP performs an incision and drainage (I&D) and then applies an Unna boot, you may have to reduce your coding from two procedures to one. No bundling issues now exist on these procedures, says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates. But that's going to change for payers that follow Correct Coding Initiative (CCI) edits. Starting April 1, new version 14.1 puts an end to also coding the strapping (29580, Strapping; Unna boot). The CCI edits bundle Unna boot strapping code 29580 into five I&D codes and one debridement code: - 10060 -- Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single - 10061 -- - complicated or multiple - 10140 -- Incision and drainage of hematoma, seroma or fluid collection - 10160 -- Puncture aspiration of abscess, hematoma, bulla, or cyst - 11000 -- Debridement of extensive eczematous or infected skin; up to 10% of body surface. Exception: You may report an Unna boot strapping with the above codes when the procedures occur on separate sites. "The edits permit you to use modifier 59 (Distinct procedural service) to break the bundle under extenuating circumstances, such as different anatomical sites, supported with documentation," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J. 2. Choose Treatment Code Based on Time Beware of one new bundle when coding inhalation treatments. You should not report an individual inhalation treatment, such as with a nebulizer, in addition to continuous inhalation treatment. CCI makes inhalation treatment code 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) a component of the more extensive 94644 (Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour). Warning: The edits do not allow you to override the bundle under any circumstances. Choose the correct code based on time following these guidelines: - Use 94640 for intermittent inhalation treatment of less than 1 hour. - Restrict 94644 only to procedures lasting at least 60 minutes, according to Medical Learning Inc.'s respiratory compliance experts. 3. Use 59 on ECG Unrelated to Monitoring How many medicine codes should you report if your FP interprets results from an electrocardiogram (ECG) and home apnea [...]