The latest Correct Coding Initiative edits (CCI 17.0), which went into effect on January 1, 2011 clarifies that typical anesthesia includes services described by new catheter and tube placement codes. Just-in codes appear in non-mutually exclusive pairs Non-mutually exclusive edits apply to services that a doctor might carry out during the same care session but that are not billable together. This is because one of the codes (the component code) is included in the services represented by the second (comprehensive) code of the pairing. You can bill individual components if the doctor doesn't carry out the entire comprehensive procedure. However, if the doctor carries out the entire (comprehensive) procedure, you should bill the comprehensive code in place of the individual parts or components.
The latest CCI edits include non-mutually exclusive edits for almost every anesthesia code when carried out with several just-in CPT codes. Coding for the anesthesia procedure overrides the following codes when the doctor provides both services during the same session.
0251T -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when carried out; with removal of bronchial valve(s), initial lobe
0253T -- Insertion of anterior segment aqueous drainage device, minus extraocular reservoir; internal approach, into the suprachoroidal space
31634 -- Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when carried out; with balloon occlusion, with assessment of air leak, with administration of occlusive substance [example fibrin glue], if carried out
43753 -- Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (example for gastrointestinal hemorrhage), including lavage if performed
43754 -- Gastric intubation and aspiration, diagnostic; single specimen (example acid analysis).
The same edits apply to anesthesia during three catheter and coronary angiography procedures:
93451 -- Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed
93456 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheterization
93457 -- Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization.
There are exceptions: Each edit pair carries a modifier indicator of “1", which means you can sometimes bypass the edit by filing your claim with a proper modifier. Ensure you have enough supporting documentation to justify payment for both codes prior to filing with a modifier such as 59 (Distinct procedural service).
Forget subsequent care with anesthesia
CPT 2012 codes brings in three just-in codes for subsequent observation care (99224-99226, Subsequent observation care, per day, for the E/M of a patient …). CCI 17.0 clarifies that standard anesthesia care includes services represented by 99224-99226. These edits carry a modifier indicator of “0", which means you cannot go for the services with a modifier to try and be paid for both codes. If you submit both codes on the same claim, you'll get an automatic denial. Source URL :- http://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/cci-170-anesthesia-overrides-bronchoscopy-in-newest-edits-article
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