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Latest CCI changes tighten E&M edits, add bundles for dermatology and cardiology, among others

Tuesday, July 01, 2014

Changes to the CCI edits for how E&M services are bundled, as well as skin lesion removal are among the key changes in the 20,729 new CCI edits effective July 1. 

There were far more additions than deletions – the July CCI removed only 212 edit pairs from the active database. Remember, the CCI edits bundle services together, typically when all of the work of one procedure is included in the other procedure. Many of these edits may be overridden with a modifier when circumstances make billing both services appropriate. 

E&M changes

The newly added CCI edits for E&M codes don’t necessarily mean a change in billing rules, but will add another defense against inappropriate payments. 

It’s already widely known that, in most instances, a provider or a group of providers of the same specialty typically cannot bill multiple E&M encounters with the same patient for the same date of service.

The CCI edits actually put that basic rule into policy. For example, there are new edits that bundle all of the established outpatient E&M codes (99211-99215) into the new patient E&M codes (99201-99205). Each lower level outpatient code is bundled into the higher level outpatient codes, so that a new edit would prevent you from billing 99214 and 99213 on the same date.

These edits may be overridden with a modifier, but it would be extremely rare for you to do so. Even if you do use the modifier, in all likelihood you would have to appeal a denial. 

Skin lesion changes

Much like the E&M changes, the new edits for skin lesion excision and destruction address coding and billing policies that were already followed by many payers. 

The destruction of lesion code 17000, as one example, has a slew of codes for lesion excision and destruction bundled into it, including 11300-11313, 11400-11446, 11450-11471 and 11600-11646. These edits may be overridden with a modifier, which you would typically do only when the lesions were in different locations.

The edits put into CCI policy longstanding prohibitions on billing for the excision of the same lesion at different sizes, or the billing of shave and destruction of the same lesion during the same encounter. You would bill only the largest measurement or most complex code (destruction, not shave, for example), in these instances.

Eye exam codes         

The ophthalmology codes 92012 and 92014 are also bundled into numerous other codes, including psychiatric codes 90867-90870, dialysis codes 90935-90937 and 90945-90947, brachytherapy codes 77750-77789 and most all of the codes in the eye and ocular adnexa section of the CPT book (65091-68899). 

Chemical peel and abrasion codes 15780-15789 also have new edits with the ophthalmology visit codes, as are most codes in the musculoskeletal surgery section in the 20000 series of CPT for procedures related to the head.

Many of the new edits with the eye surgery codes are retroactive to April 1, so be on the lookout for possible repayment demands. When use of a modifier is appropriate, these claims may be corrected and resubmitted.

Cardiology changes

Another series of new edits involve cardiovascular procedures between 92920 and 93660. Bundled into those code are ophthalmology exam codes 92012 and 92014, as well as blood vessel repair codes 35201, 35206. 35231, 35236, 35256 and 35261. These edits may be overridden by a modifier.

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