CCI 17.0 Takes Aim at Just-In Vaccine Administration Codes

The latest CCI edits (17.0) that went into effect on January 1 this year include 19,822 new active pairs and 9.778 code pair deletions. Many of the new code pair additions involve CPT codes that debuted on January 1, with CCI now halting payment if you report certain procedures together.

For example, you will find vaccine administration codes 90471 and 90473 bundled into new vaccine administration code 90460 and no modifier can separate these edits. This edit prevents mixing and matching the new immunization administration codes with the old, established immunization administration codes when delivering multiple vaccines at the same visit.

What's more, CCI bundles the new new subsequent observation care codes 99224-99226 into inpatient neonatal and pediatric critical care codes 99468-99476.

Good news on the modifier front

Not all news coming out of the latest CCI edits is bad. With effect from January 1, you will be able to use a modifier (such as 59, Distinct procedural service) to separate the edit bundling wound care management codes 97597-97602 into the just-revised debridement codes 11042-11044. Earlier, if your pediatrician performed both procedures on the same DOS, you could not collect for both no matter what; however now you'll be able to if your documentation demonstrates the separate and distinct nature of the services and you use the proper modifier.

Swapped pairs: To add to it, CCI did an about-face on several edits this round. Previously, if you reported 94660 or 94662 with an outpatient E/M code (99201-99215), CCI would reimburse you for the pressure ventilation and deny the E/M service. But then CCI version 17.0 now makes the E/M service the primary code, and the pressure ventilation code will be denied if you report the services together. These edits cannot be separated by any modifier.