CCI 20.1 Brings Edits That Apply to New Endoscopic and ERCP Codes

The latest version of CCI Edits ( CCI 20.1) that went into effect on April 1, 2014 brought in its own edits that apply to new CPT codes for gastroenterology – Endoscopic and ERCP codes. These CCI edits let you know which of these codes you can or cannot report together.

There are 4,322 new edit pairs bringing the total active list to 1,314,537 active pairs. Almost 80 percent of the new edit pairs were defined by the policy statement “CPT® Manual or CMS manual coding instructions.”

Reporting Guide Wire Insertions Separately? Don’t Make this Error

There are distinct codes for guide wire insertion over which your clinician will pass a dilator. But don’t report the guide wire insertions separately. The latest CCI edits have made this clear by bundling these codes with the modifier indicator ‘0’. As such, do not report 43226 with dilation codes – 43213, 43214, 43233.

Watch out: The latest version of  CCI Edits cci editsdo not allow you to report the code for guide wire insertion during an EGD (43248) with 43233.

Be Careful When Reporting Same Session ERCP Procedures

If you are planning on reporting ERCP procedures such as stent placements or removals together, you will have to check for bundling between these procedural codes. The April 2014 CCI edits saw several edits to these procedures; therefore it is better to check if codes are bundled before reporting them for the  same session on the same calendar DOS (date of service).

You’ll have difficulty if you are reporting stent placements with removal of foreign body or stent code, according to the latest CCI 20.1.  Likewise, you will face bundling issues when reporting CPT code for exchange of a stent with 43274 or with 43275. 

The modifier indicator for these codes is “1”. This means that you can undo the code bundling by using an applicable modifier on the column 2 code in the edits. However, only when your clinician performs these procedures in two different sites should you unbundle the codes. You should give relevant document that supports your claims to inform the payer these procedures were carried out in two sites.

Tip: To know which codes are can be bundled together, which cannot, and which allow a modifier, it’s always helpful to refer to an online CCI Edits Checker.

Transmural Injections to Celiac Plexus – Here’s What You Should Know

There are distinct CPT codes for injections of anesthetic agents or destructive neurolytic agents into the celiac plexus. However you are not allowed to report these codes when your clinician carries out these procedures during an EGD.  If that’s the case, go for 43253 in place of 64530 or 64680.  The latest CCI bundles 43253 with the codes - 64530/ 64680 – with modifier indicator “0”. This lets you know that these codes cannot be reported together under any situation.

61781, 61782, 61783 Improve Your Stereotactic Procedure Accuracy

Plus, know how to code CPT 61782

In 2011, additional stereotaxis and arthrodesis codes were just two of the benefits in the new and revised codes your neurosurgery practice had on hand.

Make Possibility for Further Arthrodesis Specificity

From last year, you are required to report arthrodesisprocedures that involve discectomy, osteophytectomy and spinal cord decompression with two novel bundled CPT codes:

22551 - (Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2)

22552 - (Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure))

CPT Code Lookup Tip: CPT code 22552, remember, is an add-on code, so you would report it with 22551 to reflect any added interspace the neurosurgeon treats below C2. Earlier, this bundled procedure would have been reported as 63075 (Discectomy, anterior, with decompression of spinal cord and/ or nerve root[s], including osteophytectomy; cervical, single interspace) for the discectomy, osteophytectomy and spinal cord/nerve decompression and CPT codes 22554-51 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; cervical below C2) (Reduced services) for the arthrodesis. This is one of numerous code pairs which were used collectively more than 90 percent of the time, encouraging CMS to request a bundled code from CPT."

Add More Stereotaxis, Neurostimulator CPT Codes

Three new stereotactic navigational codes, introduced in 2011, will rise your capability for reporting cranial and spinal procedures when your neurosurgeon uses stereotactic guidance.

CPT 61781 - (Stereotactic computer-assisted (navigational) procedure; cranial, intradural (List separately in addition to code for primary procedure))

CPT 61782 - (Stereotactic computer-assisted (navigational) procedure; cranial, extradural (List separately in addition to code for primary procedure))

CPT 61783 - (Stereotactic computer-assisted (navigational) procedure; spinal (List separately in addition to code for primary procedure))

CPT Code Lookup Tip : All the above listed three codes are add-on codes, thus you would list these with the primary procedure. Earlier, stereotactic navigation was described using 61795 (Stereotactic computer-assisted volumetric [navigational] procedure, intracranial, extracranial, or spinal [List separately in addition to code for primary procedure]).

Though, this CPT code was applied to intracranial surgery (eg. tumor resection) by neurosurgeons, to extracranial surgery (eg. sinus surgery) by otolaryngologists, as well asd to spinal surgery (eg. transarticular screw fixation) by spine surgeons. As the physician work involved varied considerably among the mass of applications, the code has been broken out to be more precise to the anatomical region being navigated with stereotactic image-guidance.

CPT® Don't Oversee These 2012 Observation Care Coding Updates

Added time guides will supplement 99218-99220 descriptors beginning Jan. 1.

If you're hardly familiarizing yourself with 2011 novel codes for subsequent observation care 99224-99226, support yourself for a couple of fresh reports about how to report these new codes, and reimburse for your deserved dollars as well as ensure accurate medical coding.

CMS Renders Finality To 99224-99226 RVUs

CPT manual presented codes for subsequent observation care, 99224 (Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity.); 99225 (Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity.); and 99226 (Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity.) beginning Jan. 1, 2011.

CMS denotes that the following value units are certainly final at the disputed levels, and will decide the payment levels for subsequent observation care under the Medicare fee schedule for 2011 and subsequent years:

99224 -- 0.82

99225 -- 1.45

99226 -- 2.17

'Treating Physician' Gets Exclusive Rights To Use 99224-99226

CMS has also specified that only treating physicians can report subsequent observation care. The agency mentions that subsequent observation care pay comprises "all the care rendered by the treating physician on the day(s) other than the initial or discharge date. Any other physicians evaluating or consulting on the observation care patient "must bill the appropriate outpatient service codes," and not the subsequent observation care codes.

Pick Out Appropriate Observation Code Based On Time

As per CPT manual, hospital observation care codes 99224-99226 and 99218-99220/99217 are applicable to an otolaryngologist when a patient gets admitted to observation (as opposed to inpatient), and then gets discharged either on the same day or on two calendar days.

Tell the difference: In case you're puzzled about the distinct functions of 99224-99226 and additional set of observation codes 99218-99220/99217, remember that the difference lie on when the service is rendered/completed.

Codes 99224-99226 in CPT manual describe observation care for a patient who is admitted to and discharged from observation on the same calendar day. In this case you would use only one code from the CPT manual to represent both services of the admission and the discharge from observation.

How often are the CCI edits updated?

Question: How often are the CCI edits updated?

Answer : The CCI edits (Source http://www.supercoder.com/coding-tools/cci-edits-checker/ ) are usually updated on a quarterly basis. Note that the CCI edits are included in the Outpatient Code Editor (OCE). Under the hospital OPPS, the CCI edits are always one version behind.

How should modifier "-25" be reported under the CCI?

Question: How should modifier "-25" be reported under the CCI?

Answer : Modifier "-25" should be appended to an evaluation and management (E/M) code when reported with another procedure on the same day of service. Appending modifier -25 to the E/M code indicates to the carriers or fiscal intermediaries that as a result of the patient's condition, the physician performed a significant, separately identifiable E/M service above and beyond the other service provided.

Where can I find information about the Correct Coding Initiative (CCI) in the Medicare manuals?

Question: Where can I find information about the Correct Coding Initiative (CCI) ( Source http://www.supercoder.com/coding-tools/cci-edits-checker/ ) in the Medicare manuals?

Answer : Information about CCI can be found in Section 20.9 of Chapter 23 of the Medicare Claims Manual http://www.cms.hhs.gov/manuals/

What's the difference between the Outpatient Code Editor edits and the CCI edits?

Question: What's the difference between the Outpatient Code Editor edits and the CCI edits?

Answer : The OCE edits and the CCI edits are two editing systems used to process fiscal intermediary (hospital outpatient) and carrier-related claims, respectively. The CCI edits are developed based on coding conventions defined in the AMA's CPT Manual, current standards of medical and surgical coding practice, input from specialty societies, and based on analysis of current coding practice. The CCI edits are used for carrier processing of physician services under the Medicare Physician Fee Schedule while the OCE edits are used by intermediaries for processing hospital outpatient services under the Hospital OPPS.

The OCE is used in processing OPPS claims. Within the OCE are over 50 OCE edits, which determine whether a specific code is payable under the hospital OPPS. Many of the CCI edits are included in the OCE edits (see edit #19, 20, 39, and 40 below). The OCE edits are used exclusively under the hospital OPPS - they are not used within the Medicare Physician Fee Schedule.
Fanimation Fans

The CCI edits (Source http://www.supercoder.com/coding-tools/cci-edits-checker/ ) always consist of pairs of HCPCS codes, and are arranged in two tables. One is the column 1/column 2 correct coding edits table, and the other is known as the mutually exclusive edits table. The OCE edits are arranged in numerical order with descriptions for each edit, as well as a claim disposition for each edit. Examples of OCE edits are listed below. For further information on the latest OCE edits within the hospital OPPS, please visit our website at http://www.cms.hhs.gov/Manuals/ to find the latest transmittal (program memorandum) on the OCE.