The latest CCI edits (17.3) that went into effect on October 1 this year, has added 1,380 new edit pairs. So if you try to report X-rays with some chest procedures, you may be in for a disaster. Here's what to watch out for:
Some of the just-in edit pairs you will want to keep an eye on bundle chest X-rays into chest tube procedures. Since these edits have a modifier indicator of 1, you may override the edits with a modifier on the column 2 code when the services are distinct.
Closer look at overriding edits
In some clinical circumstances you can override – and not ignore – CCI edits and get separate payment for bundled codes. You should first check the "modifier indicator" to figure out if you can bill services separately; first check the 'modifier indicator'.
How it functions: All edits comprise code pairs that are arranged in two columns. Codes that are listed in Column 2 are not payable if carried out on the same day on the same patient by the same provider as the code listed in Column 1; unless the edits permit the use of a modifier associated with CCI.
A "0" indicator means that you can't unbundle the two codes under any circumstances. However, an indicator of "1" means that you may use a modifier to override the edit if the clinical circumstances warrant separate payment.
The most widespread modifiers that Part B practices use to override an edit pair are 25 when used with an associated E/M code or modifier 59 when two non-E/M services are carried out and no other modifier is there to report the two separate and distinct services.
Documentation: Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury not ordinarily encountered or carried out on the same day by the same individual.
This time CCI deletes 835 pairs; a large number of those eliminate edits with vascular introduction and injection procedures in column 1. As a matter of fact, more than 10 percent of deletions involved edits with a column 1 code of 36147.
Among the deleted codes, you will particularly want to pay attention to the deletion of edits with a modifier indicator of 0.
Some of the just-in edit pairs you will want to keep an eye on bundle chest X-rays into chest tube procedures. Since these edits have a modifier indicator of 1, you may override the edits with a modifier on the column 2 code when the services are distinct.
Closer look at overriding edits
In some clinical circumstances you can override – and not ignore – CCI edits and get separate payment for bundled codes. You should first check the "modifier indicator" to figure out if you can bill services separately; first check the 'modifier indicator'.
How it functions: All edits comprise code pairs that are arranged in two columns. Codes that are listed in Column 2 are not payable if carried out on the same day on the same patient by the same provider as the code listed in Column 1; unless the edits permit the use of a modifier associated with CCI.
A "0" indicator means that you can't unbundle the two codes under any circumstances. However, an indicator of "1" means that you may use a modifier to override the edit if the clinical circumstances warrant separate payment.
The most widespread modifiers that Part B practices use to override an edit pair are 25 when used with an associated E/M code or modifier 59 when two non-E/M services are carried out and no other modifier is there to report the two separate and distinct services.
Documentation: Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury not ordinarily encountered or carried out on the same day by the same individual.
This time CCI deletes 835 pairs; a large number of those eliminate edits with vascular introduction and injection procedures in column 1. As a matter of fact, more than 10 percent of deletions involved edits with a column 1 code of 36147.
Among the deleted codes, you will particularly want to pay attention to the deletion of edits with a modifier indicator of 0.
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