Primary Care Coding Alert

The new Correct Coding Initiative edits are in, and family practice coders will need to watch out for several injection codes that have been bundled with almost every surgical procedure code in the book.

Last quarter's CCI edits gave FP coders a break, but this time around you'll have to make some adjustments. Code 36410* (Venipuncture, child over age 3 years or adult, necessitating physician's skill [separate procedure], for diagnostic or therapeutic purposes. Not to be used for routine venipuncture), used frequently by FPs, is now no longer separately billable with most surgical procedures, including the maternity codes. For example, if the FP drew the patient's blood during a postpartum care period to check for anemia, do not code separately for 36410 report only 59400 (Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care). However, CCI indicated that under special circumstances these two codes will be paid separately if the proper modifier is appended.

CCI also bundled 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) with many other codes. If you are going to bill 90780 with a procedural service on the same day, you'll need to attach an appropriate modifier to get paid. The same holds true for 36000* (Introduction of needle or intracatheter, vein) it too is bundled with a plethora of procedure codes. Among the relevant bundles is the maternity code 59400 as well as 59409 (Vaginal delivery only [with or without episiotomy and/or forceps]). Potentially, an FP may have to start an IV while delivering a baby. Coders could only report 59400 or 59409 in this case, whereas before they may have reported 36000 as well. Like the others, the modifier exception applies to 36000 if the procedure is justifiably separate. Observation Admit and E/M Edits CMS also implemented edits to deny other E/M services (such as office visits, ER visits, etc.) done on the same day as an admission to observation status (99218-99220, 99234-99236), unless a modifier is used. This is generally consistent with current CPT rules stating that when a patient is admitted to observation from another site of service (such as the office or ER), only the observation admit is to be coded. A modifier overrides the edit if, for example, the physician sees the patient in the office that morning for the flu, sends the patient home and then later that day has to admit the patient to observation because he developed a separate problem, such as chest pains. Or an FP may see a patient for asthma during an office visit, and later in the day she develops acute exacerbation and must be [...]