For example, if you are already comfortable with bundles that exist for 57155, then you are ready for the new bundles added to the new code 57156. They're the same.
Break the rest of the edits into two categories: fluoroscopy edits and E/M edits.
Consider four fluro codes as included in Gyn procedure
Your claims could face problems if you attempt to bill a fluroscopic code in addition to just about everything in the gynecology section in the CPT manual.
CCI 17.0 particularly highlights the following four fluoroscopic codes: 76000, 76001, 77001, 77002. Essentially, CCI 17.0 bundles 76000, 76001, and 77001 into some codes and only 77001 and 77002 into others.
Break down these Evaluation/Management edits
With a broad brush stroke, the latest CCI edits bundles E/M services into all delivery and delivery plus postpartum care codes. These edits carry a modifier indicator of "1", which means you can separate these bundles with a modifier so long as you can show these encounters are separately identifiable. Remember, these delivery and delivery plus postpartum care codes already include admission, subsequent hospital care, discharge, and postpartum care under CPT guidelines.
But then what's new is that you should now include observation care, which hasn't been a part of routine ob care in the past. What's more, you should include the nursing facility care, rest home care, and home care visits – which make no sense for ob patients anyway.
Antepartum care only codes 59425 Antepartum care only; 4-6 visits) and 59426 (7 or more visits) didn't escape CCI 17.0's notice. These codes now include 99201-99215 (Office or other outpatient visit ...). What's more, you can separate these edits with a modifier; but again be sure to include documentation to show payers how these services are separately identifiable. These bundles apply to the same date of service; as such, it's unlikely that you'd bill antepartum care and a separate E/M code on the same DOS unoless the E/M service was not related to pregnancy.
In the end, observation care (99217-99220, Initial observation care, per day, for the E/M of a patient …) is now part of G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) and Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory)…
Break the rest of the edits into two categories: fluoroscopy edits and E/M edits.
Consider four fluro codes as included in Gyn procedure
Your claims could face problems if you attempt to bill a fluroscopic code in addition to just about everything in the gynecology section in the CPT manual.
CCI 17.0 particularly highlights the following four fluoroscopic codes: 76000, 76001, 77001, 77002. Essentially, CCI 17.0 bundles 76000, 76001, and 77001 into some codes and only 77001 and 77002 into others.
Break down these Evaluation/Management edits
With a broad brush stroke, the latest CCI edits bundles E/M services into all delivery and delivery plus postpartum care codes. These edits carry a modifier indicator of "1", which means you can separate these bundles with a modifier so long as you can show these encounters are separately identifiable. Remember, these delivery and delivery plus postpartum care codes already include admission, subsequent hospital care, discharge, and postpartum care under CPT guidelines.
But then what's new is that you should now include observation care, which hasn't been a part of routine ob care in the past. What's more, you should include the nursing facility care, rest home care, and home care visits – which make no sense for ob patients anyway.
Antepartum care only codes 59425 Antepartum care only; 4-6 visits) and 59426 (7 or more visits) didn't escape CCI 17.0's notice. These codes now include 99201-99215 (Office or other outpatient visit ...). What's more, you can separate these edits with a modifier; but again be sure to include documentation to show payers how these services are separately identifiable. These bundles apply to the same date of service; as such, it's unlikely that you'd bill antepartum care and a separate E/M code on the same DOS unoless the E/M service was not related to pregnancy.
In the end, observation care (99217-99220, Initial observation care, per day, for the E/M of a patient …) is now part of G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) and Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory)…
I actually enjoyed reading through this posting.Many thanks.
ReplyDeleteMedical Billing and Coding Services