CCI 18.0 includes new edits for the new facet destruction codes

by: Julia Kyles

Published Feb 1, 2012

If you assumed CCI 18.0 would simply crosswalk the edits for deleted facet nerve destruction codes (64622 – 64627) to the new codes (64633 – 64636) you were mostly right. The latest version of the Correct Coding Initiative also bundles more than a dozen new procedures into your facet destruction services and many of the new edits that impacted your pain management coding as of Jan. 1, 2012 involve new or revised codes (APCPS 11/2011).

Note: An annotated spreadsheet with all of the new edits is available on the APCPS website, but here is a review of the changes your practice needs to code correctly this quarter:

Facet denervation edits include more than fluoroscopycodes. You expected to see imaging codes 77003 and 77012 bundled into these services (APCPS 10/2011). Note: Like the pre-existing imaging edits, the new edits both have a modifier  indicator of 1, meaning that when appropriate you can unbundle the imaging service with a modifier.

Effective Jan. 1, tendon injections and trigger points (20550 – 20553) are also bundled into facet destructions.

Note: The tendon and trigger point injections are the only other new edits that can be overridden with a modifier. The remaining edits have a modifier indicator of 0 – you can never use a modifier to break the edit:

1. CCI 18.0 adds cervical and thoracic epidurals and facet injections (62310 and 64490, respectively) to the list of services now included in a facet destruction procedure. Previously only62311 – 62319 and 64493 were listed in the edits.
2. Three additional somatic nerve injection codes now appear on the list. Don’t try to report a single or continuous brachial plexus block or an axillary nerve block (64415 – 64417) on the same day you perform facet destruction on the same patient/same day.
3. Finally, CCI 18.0 bundles the two new evoked potential tests for upper and lower limbs (95938 and 95939) into facet destruction procedures.

Tendon and trigger point injections now include the new codes for multilayer compression of the thigh and leg and upper arm, forearm, hands and fingers (29582and 29584, respectively). These edit pairs do have a modifier indicator of 1 so you can unbundle them with a modifier when appropriate.

Minor, intermediate and major joint/bursa injection codes (20600 – 20610) include four new codes. In addition to the multilayer compression codes also bundled into tendon and trigger point injections, CCI 18.0 bundles 29583 (multilayer compression of the upper arm)and 20527 (Dupuytren’s contracture – enzyme injection) into these services. Ganglion cyst injections(20612) also include 20527.

New pain pump reprogramming codes. The latest set of edits bundle several codes into 62369 – 62370, but there’s nothing really new or unexpected here. CCI 18.0 includes codes that are already bundled into 62368 (electronic analysis with reprogramming):

Vascular injections: 36000 and 36410.

Transcatheter therapy: 37202.

Pain injections: 62318 – 62319, 64415 – 64417

and 64450 and 64490.

IV infusions: 96360 and 96365.

Facet injections (ultrasound guidance): 0213T and 0216T.

It’s also no surprise that pain pump refill and maintenance codes (99590 – 95991) are bundled into the new analysis codes with a modifier indicator of 0. As we told you last November, CPT 2012 specifically states you can’t report both codes for the same patient on the same day (APCPS 11/2011).

CCI 18.0 also prevents you from billing 62369 with 62367 or62368 (electronic analysis and electronic analysis with reprogramming), or 69990 (micro-surgery add-on). 62370 also includes those three codes as well as 62369. These edits all have a modifier indicator of 0.

Remember: 62370 requires a physician’s skill, therefore documentation from the provider should clearly indicate the need for the physician skill level. This could be supported by difficult port access.

Nerve blocks, neurostimulators & evoked potential tests. CCI 18.0 bundles the following new codes into all but two nerve block and neurostimulator implant procedures with a modifier indicator of 0:

95938   Somatosensory testing, upper and lower limbs

95939   C-motor evoked upper and lower limbs

Note: Only 64450 (greater occipital nerve block) and 64550 (application of surface transcutaneous stimulators) are not impacted by this new edit.

Nerve blocks, neurostimulators & peripheral stimulators. The following four new Category III codes have been bundled into codes 64550 – 64595:

0282T   Periph field stimul trial.

0283T   Periph field stimul perm.

0284T   Periph field stimul revise.

0285T   Periph field stimul analys.

CCI 18.0 gives these edits a modifier indicator of 0, but this is another expected edit since CPT 2012 states you may not report the Category III codes with the neuro codes.

Other nerve destruction codes. Just as trigger points and the new evoked potential tests are bundled into the facet denervation codes, they’re also bundled into the remaining destruction codes (64600 – 64681).

Remember: Edits that bundle 95938 and 95939 into the destruction codes cannot be broken with a modifier. However, when appropriate, you may use a modifier to unbundle a trigger point service.

Critical Care services. There are a handful of new edits for 99291 – 99292 (APCPS 4/2011). CCI 18.0 bundles subsequent intensive care for very low birth weight, low birth weight and recovering infants (99478 – 99480) into critical care services with a modifier indicator of 0.

The new edits also bundle external electric cardioversion (92960) into your critical care services. However, this edit has a modifier indicator of 1 so you may break the edit when it is appropriate.

New MUEs, new pain codes. Don’t forget the Medically Unlikely Edits (MUEs). These edits automatically limit the number of times you may report a service for the same patient on the same day. CCI set the MUEs for the following new codes at 1: 0278T, 0279T, 0280T, 0281T, 0282T, 0283T, 0284T, 0285T, 62369, 62370, 64633, 64635, 95938, 95939.

abinsights Contact Information

abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance.  Send to:  Anesthesia Billing, Inc.,     P O Box 388, Newton, KS  67114-0388.  Phone 316-281-3700.  Fax 316-282-4322.

Our purpose is to help you meet inevitable challenges.  We hope to deliver practical knowledge and solutions drawn from top resources and business publications in every issue, knowledge you can use today.

Reasonable attempts have been made to be accurate.  However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ.  Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations.  For information specific to your practice, consult a qualified professional.

The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice.  Specific questions about how this information affects your particular situation should be addressed to your attorney.

Editor:  Philip Blann (pblann@anesthesiabilling.com).