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.
