Pulmonology Coding Alert

If you bill J2001 for lidocaine injections, the latest edits will get your attention

If your practice reports J2001 for lidocaine injections with sputum specimen collections, you can expect a flood of denials -- all thanks to the new edition of the National Correct Coding Initiative (NCCI) edits.

NCCI version 10.2, effective July 1, declares 108 new bundles that affect pulmonologists -- but the good news is that you may be able to use a modifier to separate the edits if you can prove the separate and distinct nature of the services.

Billing 30000 and 31000 Codes on the Same Day? Not Without -59

The latest NCCI edits include several mutually exclusive codes from the nose (30000-30999), accessory sinuses (31000-31299), larynx (31300-31599) and trachea/bronchi codes (31600-31899).

The bulk of these bundles will affect your coding when the physician administers a lidocaine injection (J2001, Injection, lidocaine HCl for intravenous infusion, 10 mg) with incision or excision procedures on the nose or accessory sinuses, or collects sputum specimens (89220, Sputum, obtaining specimen, aerosol-induced technique [separate procedure]) with incision, endoscopy and catheter aspiration codes for the larynx and trachea.

These new edits should have no effect on your practice's bottom line, says Cheryl Scott, CPC, CPC-H, CCS, CCS-P, coding consultant with the HealthTexas Provider Network in Dallas. Local anesthesia was always bundled into a surgical procedure, Scott says. According to CPT guidelines, "the following services are always included in addition to the operation per se: local infiltration, metacarpal/metatarsal/digital block or topical anesthesia," Scott says.

These new bundles will affect your reporting from July 1 through Sept. 30. The edits are pairs of CPT or HCPCS Level II codes that are not separately payable except under certain circumstances, says Lisa Center, CPC, quality coordinator with Freeman Health System in Joplin, Mo. The edits are applied to services billed by the same provider for the same beneficiary on the same date of service. All claims are processed against the NCCI tables. As of July 1, J2001 is considered a component of more than 1,100 surgeries and procedures.

Reality: The bundled pairs indicate a "1" in the modifier column. This means that you cannot report bundled codes if they occur on the same day without an appropriate modifier such as -59 (Distinct procedural service) or -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Documentation is always a must to justify medical necessity for the physician completing both procedures.

Note: Go to www.cms.hhs.gov/physicians/cciedits/default.asp for links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.