CCI 16.0: Now Allows a Modifier to Separate Hundreds of Edits

But other new bundles that 16.0 has in store might put a dent in your reimbursement. You may still be poring through your 2010 CPT manual, but the new edition of CCI, effective Jan. 1, is already looking to make some code pairings impossible. The Correct Coding Initiative (CCI) released version 16.0 earlier this week, revealing 24,060 [...] Related articles:

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Santa brings gifts; CCI brings bundles

But other new bundles that 16.0 has in store might put a dent in your reimbursement.

You may still be poring through your 2010 CPT manual, but the new edition of CCI, effective Jan. 1, is already looking to make some code pairings impossible.

The Correct Coding Initiative (CCI) released version 16.0 earlier this week, revealing 24,060 new active pairs and 869 modifier changes, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a Dec. 8 announcement.

Good news: CCI version 16.0 attempts to untangle at least one troublesome set of edits in its next round with the announcement that effective Jan. 1, you’ll be able to use a modifier to separate the edits bundling E/M codes (99201-99215;99221-99223) into over 100 of the radiation oncology codes.

For instance, if you currently report new patient E/M code 99204 with 77261 (Therapeutic radiology treatment planning; simple), Medicare will deny the E/M code and no modifier can separate the edits. However, CCI 16.0 makes the modifier indicator for these bundles “1,” meaning you will be able to separate the edits with a modifier in some situations.

The bad news …

The CCI will eliminate your chances of collecting for both pancreatotomies (48150-48154) and certain cholecystectomies (47605-47610). Although previous editions of the CCI edits gave these pairings a “1” indicator (meaning you could use a modifier to separate the edits,) the pairs are assigned a “0” indicator effective Jan. 1.

Most of the new CCI bundles affect codes that debuted in CPT 2010. For example, you’ll find over 100 codes bundled into new tumor excision code 25071 (3 cm or greater).

The fact that some skin surgery codes, such as 12001-12007 (Simple repair of superficial wounds) now bundle into the new tumor excision codes “makes perfect sense,” says Randall Karpf, coding consultant with East Billing in Connecticut. “A simple repair can be done during the course of the excision, so you’d bundle it unless the separate encounter or site rules apply.”

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