Hot Coding Topics / Provider News

Check CCI Edits For New Vaccine Administration Codes

Many of the new code pair additions involve CPT codes that debuted on Jan. 1, with CCI now halting payment if you report certain procedures together.

For instance, you’ll find vaccine administration codes 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid])and 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]) bundled into new vaccine administration code 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component), and no modifier can separate these edits. This edit prevents mixing and matching the new immunization administration codes with the old, established immunization administration codes when delivering multiple vaccines at the same visit.

In addition, CCI bundles the new subsequent observation care codes 99224-99226 into inpatient neonatal and pediatric critical care codes 99468-99476.

CCI Has Good News on the Modifier Front

Not all news coming out of the new edition of CCI is bad. Effective Jan. 1, you’ll be able to use a modifier (such as 59, Distinct procedural service) to separate the edit bundling wound care management codes 97597-97602 into the newly-revised debridement codes 11042-11044. In the past, if your pediatrician performed both procedures on the same date of service, you could not collect for both no matter what, but now you will be able to if your documentation demonstrates the separate and distinct nature of the services and you append the appropriate modifier.

Swapped pairs: In addition, CCI did an about-face on several edits this round. In the past, if you reported 94660 (Continuous positive airway pressure ventilation) or 94662 (Continuous negative pressure ventilation) with an outpatient E/M code (99201-99215), CCI would reimburse you for the pressure ventilation and deny

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February 3, 2011
2011 Medicare Physician Fee Schedule / CPT 2011 / CPT and RBRVS Annual Symposium / Hot Coding Topics

Peds Win Per Component Vaccine Admin Codes, Lose Requested PE RVUs

Pediatricians who were thrilled with CPT 2011’s move to paying vaccines per component got a setback from Medicare’s rejection of the recommended RVUs for new vaccine administration codes 90460 and 90461.

The Relative Update Committe recommended that the 2011 Medicare Physician Fee Schedule and Resource Based Relative Value Scale assign 0.20 practice expense (PE) RVUs to 90460 and 0.16 PE RVUs to 90461. But CMS disagreed with the proposal. “We disagree with the recommendations and will maintain 0.17 RVUs for code 90460 and 0.15 RVUs for code 90461 since these codes would be billed on a per toxoid basis,” said Kenneth Simon, MD, MBA, Senior Medical Officer, Center for Medicare and AMA CPT Editorial Panel Member, in “Medicare Physician Payment Schedule 2011 Changes and Beyond” at the CPT® and RBRVS 2011 Annual Symposium on Nov. 10, 2010.

The increased PEs represent an increase in RVUs from the 2010 values for comparable codes 90465/90467 and 90466/90468. The RUC requested the increase in value due to increased time for patient education. Since the new codes are valued per component, CMS felt no increase was warranted.

CMS assigned RVUs to 90460 and 90461 by crosswalking them with the values of the noncounseling vaccine administration codes 90471 and 90472. This means that new code 90460 has the same RVUs as 90471, and each unit of 90461 has the same RVUs as 90472.

The work and total RVUs for the codes include:

<td width="203"
Code PE  RVU  RUC Proposed PE  RVU MPFS Accepted Total RVUs
90460 0.20 0.17 0.59
90461 0.16 0.15 0.3
90465

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November 29, 2010
Coder's Cranium

Boost Injection Pay — Just Ask, Listen for Missed Items

Uncircled vaccines, administrations could cost your practice 10%.

Think increasing payments in 2010 is a fairy tale? Your magic wand is right at your front desk.

“Check-out coding can have a significant financial impact,” reported Norman “Chip” Harbaugh, MD, in...

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April 28, 2010