Hot Coding Topics / modifier 59 / NCCI

NCCI Edits: Watch Out For These Endoscopy Bundles

Code 31575 includes 92511 and 31231 except under these conditions.

Singling out the correct endoscopy code when your otolaryngologist examines multiple areas in the sinuses and throat isn’t always easy, but in most cases it’s imperative to settle on one, according to National Correct Coding Initiative (CCI) edits. You can adhere to these edits and avoid payback requests if you stick to these guidelines.

3 Rules Guide the Way

Rule #1: Never report 92511 (Nasopharyngoscopy with endoscope[separate procedure]) and 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) together, says Stephen R. Levinson, MD, otolaryngologist and coding consultant based in Easton, Conn. Code 92511 is a component of Column 1 code 31231. The bundle has a modifier indicator of “0” — thus, no modifier can break this bundle.

Rule #2: Code 92511 is a component of Column 1 code 31575 (Laryngoscopy, flexible fiberoptic; diagnostic) but a modifier is allowed in order to differentiate between the services provided (that is, you may append modifier 59 [Distinct procedural services] if there are separate and identifiable services with separate medical indications). Report 92511 in conjunction with 31575 for the same encounter, says Levinson, only if the following conditions are met:

  • there are separate medical indications for examining each area (for instance, 784.49 for hoarseness with 31575 in an adult patient with a hyperactive gag reflex and 381.4 for a unilateral or bilateral middle ear effusion with 92511, which would be a rare occurrence), and
  • the ENT uses a different scope for each, separate procedure because there is a documented reason that the fiberoptic scope did not provide adequate visualization of the nasopharynx. “This would be highly unlikely,” emphasizes Levinson.

Rule #3: Code 31231 is a component of Column 1 code 31575 but a modifier is allowed in order...

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June 1, 2010
CCI / Medicare / NCCI / Provider News

2 Reasons to Think Twice Before Reporting 78070 With 78803

Sometimes CCI compliance requires looking beyond the edit pairs.

Correct Coding Initiative (CCI) edits don’t bundle SPECT (78803) and planar (78070) parathyroid imaging codes, but coding experts often tell you not to code the two together for SPECT and planar parathyroid imaging on the same date.

Add some method to this madness by looking at the information offered by two coding resources, the Society of Nuclear Medicine (SNM) and the NCCI Policy Manual for Medicare Services (CCI Manual).

1. SNM Singles Out 78803

SNM’s online Practice Management Coding Corner features a Q&A that recommends reporting 78070 (Parathyroid imaging) for planar imaging alone, but 78803 (Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent[s]; tomographic) for parathyroid SPECT imaging with or without planar, says Jackie Miller, RHIA, CCS-P, CPC, vice president of product development for Coding Metrix Inc. in Powder Springs, Ga.

Support: “Choose the single code that describes the protocol and procedure performed,” states the Q&A, located at http://interactive.snm.org/index.cfm?PageID=2442&RPID=1995. SNM “would NOT recommend coding both CPT codes,” the article notes.

2. CCI Makes the Case for SPECT Code

Although there is notyou won’t find any a specific edit bundling 78070 and 78803, CCI does address the SPECT/planar issue in the CCI Manual, says Miller.

CCI Manual, Chapter 9, Section E.2, explains that you may not report a SPECT study and planar study of the same limited area because “Single photon emission computed tomography (SPECT) studies represent an enhanced methodology over standard planar nuclear imaging. When a limited anatomic area is studied, there is no additional information procured by obtaining both planar and SPECT studies.”

Bonus tip: The manual indicates you may report both planar and SPECT codes only when the size of the scanned area makes both sets necessary, such as with whole body bone scans with...

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May 25, 2010
CCI / NCCI / Provider News

Avoid Denials With This Lowdown on Newborn CCI Bundles

These edits took effect April 1, so start observing them yesterday.

The latest version of the Correct Coding Initiative (CCI) has an edit that family practice coders should note – especially if the practice treats newborn patients.

Get to know the new CCI 16.1 edit and get ready to observe it with this expert breakdown. Check Column 1 on These Hospital E/Ms According to CCI 16.1, these codes are in column 1 of the mutually exclusive edits:

  • 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused examination; medical decision making that is straightforward or of low complexity …)
  • 99232 (… an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity …)
  • 99233 (… a detailed interval history; a detailed examination; medical decision making of high complexity …).

Column 2 of these edits includes these codes:

  • 99460 (Initial hospital or birthing center care, per day,for evaluation and management of normal newborn infant)
  • 99461 (Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center)
  • 99462 (Subsequent hospital care, per day. for evaluation and management of normal newborn).

Translation: An FP may not report both normal newborn care and subsequent hospital care for a newborn on the same date of service. If the FP performs normal newborn services (99460-99462) on the same date that the newborn later becomes ill and receives subsequent hospital care (99231-99233), you should only report a code from the 99231-99233 code set, explains Kent Moore, manager of health care financing and delivery systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan.

The...

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May 20, 2010
CCI / CPT / Hot Coding Topics / modifier 59 / NCCI

CCI 16.1: Seize the Opportunity to Report 0193T — But Don’t Get Tripped Up By These Edits

Overlooking these new Interstim and hemorrhoid destruction bundles could mean denial headaches.

Payers like Noridian Part B will cover the female stress urinary incontinence treatment code 0193T, but before you submit a 0193T claim, you’ll have to check with the...

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April 14, 2010
CCI / Coding Challenge / mutually exclusive / NCCI

Correct Coding Initiative: ‘Mutually Exclusive’ and ‘Bundled’ Defined

Decipher what column 1/column 2 means in this neurosurgery bundle example.

Question: Would you explain what the differences are between mutually exclusive and “column 1/column 2″ edits that come from the Correct Coding Initiative (CCI)?

Florida Subscriber

Answer: Mutually exclusive...

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April 11, 2010
CCI / HCPCS / Hot Coding Topics / Medicare / modifier 59 / NCCI / Oig / Oncology

OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage

Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions. If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test. Append 59 [...] Related articles:

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February 21, 2010