CCI Edits
Besides, get acquainted with endoscopic and bone marrow limitations.
Keeping pace with Correct Coding Initiative (CCI) quarterly updates to the edit-pair lists will merely get you so far in Medicare billing compliance. You also require studying guidance that CMS lists in the National Correct Coding Initiative Policy Manual, the latest being a Jan. 2012 update that could have noteworthy impact on your general surgery medical billing and coding.
We've got the lowdown on a few significant changes that are sure to affect the way you code your services.
Background: Every year, CMS updates the Policy Manual, which proposes rationale for several CCI edits, plus describing acceptable scenarios for overriding some edit pairs.
Bundle Imaging Into These Services
When it comes to emergency endotracheal intubation procedures (31500), Swan-Ganz catheter insertions (93503), plus chest tube insertions (32422, 32550, 32551), your surgeon is most probably used to carrying out a post-procedural x-ray to determine that the tubes are in the correct position. Still, as CMS considers that imaging to be normally associated with the procedure, the CCI edits have included the imaging payment into the RVUs for the insertions.
A chest radiologic examination CPT® code (e.g., 71010, 71020) must not be reported distinctly for this radiologic examination.
That's not all: The Policy Manual talks about other imaging restrictions, for instance not reporting +76937 (Ultrasound guidance for vascular access ...) in addition to 36147 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/ fistula) …). Likewise CMS says you must not distinctly report operative angiograms or venograms carried out as part of percutaneous interventional vascular procedures using diagnostic codes (such as 75820,Venography, extremity, unilateral, radiological supervision and interpretation).
Watch Bone Marrow Boundaries
While a surgeon performs a bone marrow aspiration and biopsy for the same patient on the same day, the Policy Manualupdate has so much to say about how you report those particular services:
Keeping pace with Correct Coding Initiative (CCI) quarterly updates to the edit-pair lists will merely get you so far in Medicare billing compliance. You also require studying guidance that CMS lists in the National Correct Coding Initiative Policy Manual, the latest being a Jan. 2012 update that could have noteworthy impact on your general surgery medical billing and coding.
We've got the lowdown on a few significant changes that are sure to affect the way you code your services.
Background: Every year, CMS updates the Policy Manual, which proposes rationale for several CCI edits, plus describing acceptable scenarios for overriding some edit pairs.
Bundle Imaging Into These Services
When it comes to emergency endotracheal intubation procedures (31500), Swan-Ganz catheter insertions (93503), plus chest tube insertions (32422, 32550, 32551), your surgeon is most probably used to carrying out a post-procedural x-ray to determine that the tubes are in the correct position. Still, as CMS considers that imaging to be normally associated with the procedure, the CCI edits have included the imaging payment into the RVUs for the insertions.
A chest radiologic examination CPT® code (e.g., 71010, 71020) must not be reported distinctly for this radiologic examination.
That's not all: The Policy Manual talks about other imaging restrictions, for instance not reporting +76937 (Ultrasound guidance for vascular access ...) in addition to 36147 (Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/ fistula) …). Likewise CMS says you must not distinctly report operative angiograms or venograms carried out as part of percutaneous interventional vascular procedures using diagnostic codes (such as 75820,Venography, extremity, unilateral, radiological supervision and interpretation).
Watch Bone Marrow Boundaries
While a surgeon performs a bone marrow aspiration and biopsy for the same patient on the same day, the Policy Manualupdate has so much to say about how you report those particular services:
- When the surgeon carries out bone marrow aspiration alone, the appropriate CPT code 2012 is 38220 (Bone marrow; aspiration only).
- When the physician carries out bone marrow biopsy alone, the suitable code is 38221 (Bone marrow; biopsy, needle or trocar).
- When the physician carries out bone marrow aspiration and biopsy at distinct sites or separate patient encounters, you may report CPT code 2012 38220 and 38221 together.
When the physician carries out bone marrow aspiration as well as biopsy at the similar site through the same skin incision, you must not report 38220 along with 38221. As an alternative, you must report 38221 and G0364 (Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service) to Medicare payers.
CCI Edits Update: The Policy Manual also maintains that you must not list CPT code 2012 38220 with a spinal osteotomy, vertebral fracture repair, spinal arthrodesis, spinal fusion, laminectomy, spinal decompression, or vertebral corpectomy CPT code in case the bone marrow aspiration is obtained from the surgical field.
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