CCI 18.0: Know The Meaning Behind These New Pelvic Repair, Paracentesis Edits

You learned how to use the novel codes; now you have to apply these bundles.

Take a moment to learn how CCI edits affects your Implanon, paracentesis, EMG, pelvic exent, and colpopexy services. Here's the good news: Even though you'll see a diverse array of allowed modifier use, most of these edits reflect either CPT guidelines or common sense.

1. Pelvic Repair Edits Make Sense Because of 15777's Intent

New add-on code 15777 (Implantation of biologic implant) gets the CCI 18.0 treatment, in that CPT codes 45560, 57240-57265, and 57285 all bundle 15777.

This makes sense when you take in account the intent of this code. CPT instructions inform you not to use this code in place of 57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [List separately in addition to code for primary procedure]). To sum up, you can and must use 57267 with CPT codes 45560, 57240-57265, and 57285 when suitable. The same is not true for 15777.

The modifier indicator is a "1," which implies that you can separate this bundle with a modifier (such as, 59, Distinct procedural service).

2. Pick Apart These New Paracentesis Codes' Edits

Keep in mind that the new parancentesis CPT codes 49082 (Abdominal paracentesis [diagnostic or therapeutic]; without imaging guidance), 49083 (... with imaging guidance), and 49084 (Peritoneal lavage, including imaging guidiance, when performed)? Though only a gyn-oncologist will possibly have a need to report these codes, you must be aware of the bundles that affect them.

The entire abdominal hysterectomy codes (58150-58210), the pelvic exent procedure code (58240), and cancer codes 58950-58958 now bundle the novel codes 49082-49084.

Some CCI edits have a modifier indicator of "1," implying that you can separate them with a modifier, and others with a "0," implying you cannot.

3. Think Again Before Reporting 95938 With EMGs

Electromyography studies (EMG) did not emit CCI 18.0's notice.

As per CCI edits, codes 51784 (Electromyography studies [EMG] of anal or urethral sphincter, other than needle, any technique) along with 51785 (Needle electromyography studies [EMG] of anal or urethral sphincter, any technique) now bundle novel code 95938 (Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs).

You can separate these services with a modifier (such as, 59), as these edits have a modifier indicator of "1".

4. Don't Slip These Pelvic Exent and Colpopexy Edits

As per CCI edits, you have two more edits that could influence your ob-gyn practice, however be cautious: one edit has a modifier indicator of "1" and the other a modifier indicator of "0."

The pelvic exent CPT 58240 (Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube[s], with or without removal of ovary[s], with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof) at the present bundles 0288T (Anoscopy, with delivery of thermal energy to the muscle of the anal canal [e.g., for fecal incontinence]).