2014 brings big volume of changes to CCI edits

January 30th, 2014 - Scott Kraft
Categories:   Bundling   Coding  
0 Votes - Sign in to vote or comment.

Expect the biggest set of CCI changes you’ll see in 2014 to take effect on Jan. 1, as the edits are synched up to CPT® and HCPCS code changes that start next year.

There are 61,120 new edit pairs coming next year, along with 13,107 deletions and 137 modifier changes.

Many of the new edits won’t impact your billing decisions – at least not yet. There are four new E/M codes next year – 99446-99449 – to be used for billing phone consultations based on the length of the consultation.

Though those codes have a “B” status indicator in the 2014 final fee schedule, which means they’re always bundled anyway, a large number of the new edits coming in January bundle those codes into other services. Looks like Medicare, which traditionally pays for very few non face-to-face encounters, is serious about making sure that it does not pay for these.

Here are some new edit pairs to look for in January:
  • New CPT® code 10030, image-guided fluid drainage by catheter, will have hundreds of codes bundled into it, including integumentary repair codes (11055-13153), Unna boot and strapping codes (29580-29582), venipuncture codes (36000-36640), injection codes (62310-62319 and 64400-64530) and a number of medicine and E/M codes. Most of these edits may be overridden with a modifier – the injection code edits cannot. Conversely, 10030 is bundled into a number of musculoskeletal codes.
  • Transitional care management codes 99495 and 99496 are bundled into hundreds of codes across the CPT® spectrum, duplicating many of the edits involving the phone consultation visits noted above. Most of these edits may not be overridden with a modifier.
  • New breast biopsy and placement codes 19081-19086 has a slew of integumentary codes in the 12000 series bundled into it, as well as the injection codes noted in the new edits for 10030. Most may be overridden with a modifier when appropriate, with the exception of the placement codes and the injection code pairs. Many of these edits also apply when 19271-19288 the primary code. 19271-19272 are chest excision codes, the 19281-19288 series are breast placement device codes.
  • Osteotomy codes 22220-22224 have bone marrow aspiration code 38220 and harvesting code 38230 bundled into them. These edits may not be overridden with a modifier. Vertebroplasty codes in the 22500 series are also impacted by these edits.
  • Three new foreign body removal codes (23333-23335) have a number of other codes from the musculoskeletal system bundled into them, as well as injection codes from the 64400 series noted above and most E/M codes. Few of these edits can be overridden with a modifier.
  • Eight newly created transcatheter aortic valve replacement codes (33361-33369) are the subject of numerous edits. Bundled into them are thoracostomy codes 32551-32557, a handful of catheterization codes in the 36000 series, and aortagrophy and angiography codes in the 75000 series. Most of these may be overridden with a modifier. 33366 also has edits with a number of integumentary repair codes and E/M services.
  • New esophagoscopy code 43229 has a number of services bundled into it, notably integumentary repair codes, most injection codes and E/M services. Most can be overridden with a modifier, but not the injection edits. Most of these edits will also apply to new flexible EGD code 43233 and new imaging codes between 43253-43278 as well.
  • Newly added chemodenervation codes 64616 and 64617 will have most of the injection codes and E/M services bundled into them, as well as medicine codes in the 93000 series. The majority of these edits may be overridden with a modifier.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

​​Polysomnography Services Under OIG Scrutiny
September 2nd, 2021 - Raquel Shumway
The OIG conducted a study dated June 2019 wherein they indicated that there were approximately $269 million in overpayments for polysomnography services for the period of 2014 through 2015. According to the OIG “These errors occurred because the CMS oversight of polysomnography services was insufficient to ensure that providers complied with Medicare requirements and to prevent payment of claims that didn’t meet those requirements.” So what are those requirements?
Medicare Advantage - The Fastest Growing Government-Funded Program Undergoing Multiple Fraud Investigations
August 16th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Medicare Advantage is the fastest growing form of government-funded healthcare and the rate of fraud within this segment has come under increased scrutiny. Funding is determined by the health status of each beneficiary; therefore, accurate coding based on detailed documentation makes the medical record vital to the process because some ...
Billing Dental Implants under Medical Coverage
August 12th, 2021 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient’s medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.    Implants could be considered ...
New Codes for COVID Booster Vaccine & Monoclonal Antibody Products
August 10th, 2021 - Wyn Staheli, Director of Research
New codes have been announced for the COVID-19 booster vaccine, Novavax vaccine, and monoclonal antibody treatment.
Medicare's ABN Booklet Revised
July 29th, 2021 - Wyn Staheli, Director of Research
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Chronic Pain Coding Today & in the Future
July 19th, 2021 - Wyn Staheli, Director of Research
Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.
How Does Global and Professional Direct Contracting (GPDC) Affect Risk Adjustment?
July 15th, 2021 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
CMS recently announced the 53 Direct Contracting Entities (DCEs) that will be participating in the April 1, 2021 through December 31, 2021 Global and Professional Direct Contracting (GPDC) Model. Among those participating is Clover Health Partners, who runs an in-home primary care program that has the potential to help Medicare ...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association