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Fourth quarter coding correct edits released

Radiology Administrator's Compliance and Reimbursement Insider, November 1, 2005

 

By Jackie Miller, RHIA, CPC

CMS has released version 11.3 of the National Correct Coding Initiative (NCCI) edits. These edits took effect October 1 for claims filed to Medicare carriers. Hospital claims will not be subject to the version 11.3 edits until January 1.

Diagnostic radiology edits

Reconstruction (76375) is now a component of all the diagnostic nuclear medicine studies listed in CPT with the exception of dual photon absorptiometry bone density exam (78351), which is not covered by Medicare. These edits can be overridden with a modifier, which would be appropriate if reconstruction of a tomographic exam (e.g., CT) were performed on the same day as a nuclear medicine study.

Subcutaneous or intramuscular injection (HCPCS code G0351) is also a component of most nuclear medicine studies under the new edits. The edit can be overridden with a modifier (e.g., if a patient receives an injection that is unrelated to the nuclear exam).

CT without contrast is now a component of PET (78811-78813) and PET-CT (78814-78816) tumor imaging studies. For example, CT of the brain (70450) is now a column two code for column one codes 78811-78816. CT with contrast and CT without and with contrast are not included in this batch of new edits. The edits can be overridden with a modifier, presumably if a diagnostic CT scan is performed on the same day as a PET or PET-CT study.

Limited area PET tumor imaging (78811) is now a component of the skull base to mid-thigh exam (78812) and whole-body exam (78813). It is also a component of all the PET-CT exams (78814-78816). Similarly, skull base to mid-thigh PET (78812) is a component of whole-body PET (78813) and all of the PET-CT tumor imaging exams (78814-78816).

Whole-body PET (78813) is also a component of all the PET-CT codes. These edits cannot be overridden with a modifier.

Limited-area PET-CT (78814) is a component of the skull base to mid-thigh PET-CT exam (78815) as well as the whole-body PET-CT (78816). Skull base to mid thigh PET-CT is a component of whole body PET-CT (78816). These edits cannot be overridden with a modifier.

Interventional radiology

Subcutaneous or intramuscular injection (G0351) and IV push (G0353-G0354) are now components of various interventional radiology procedures, including

  • endovascular repair of thoracic aneurysm (0033T-

    0037T)

  • endovascular repair of abdominal aneurysm (0078T)

  • vertebral stent placement (0075T)

  • fine-needle aspiration (10022)

  • venous and arterial catheter placements (36000-

    36247)

  • declotting of vascular access device (36550)

    All of these edits can be overridden with a modifier.

    Percutaneous transluminal angioplasty (PTA) (35458 and 35475) is now bundled into cervical carotid stent placement (37215-37216).

    This edit makes sense because by definition, carotid artery stent placement includes PTA. The edit can be overridden with a modifier for PTA of other locations.

    Various injection and infusion codes (including G0345, G0347, G0351, G0353, and G0354) are now components of bone marrow aspiration and biopsy (38220-38221), posterior fossa myelography (70010), and cisternography (70015). These edits can be overridden with a modifier.

    Radiation oncology

    Clinical brachytherapy services (77750-77790) now include various additional evaluation and management (E/M) services such as hospital discharge day management (99239) and neonatal intensive care (99298-99299).

    CMS has deleted edits that bundled E/M services into stereotactic radiosurgery (code 61793). Also gone are edits that bundled actinotherapy (96900) and photochemotherapy (96910-96913) into radiation treatment delivery (77402-77416) and port films (77417).

    CMS has also deleted edits that bundled confirmatory consultations and prolonged E/M services into simple interstitial radiation source application (77776). Additionally, photodynamic therapy (96567) no longer includes radiation treatment delivery (77401-77416) or port films (77417).

    The modifier status has been changed from 0 (no modifier will override the edit) to 1 (modifier is allowed) on edits that bundle various E/M services into simple interstitial radiation source application (77776). Among the E/M services affected by this change are nursing facility assessments and subsequent nursing facility care.

    Insider source

    Jackie Miller, RHIA, CPC, senior consultant, Coding Strategies, Inc., 5041 Dallas Hwy., Ste. 606, Powder Springs, GA 30127; 770/445-5566; jackie.miller@codingstrategies.com.

     

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