15271-+15278 and Beyond: Navigate Edit Pairs to Boost Pay

Recognize standard surgical services to steer through bundle traps.

Not one novel CPT® 2012 code that you're expected to use in your general surgery practice escapes the newest edition of Medicare's Correct Coding Initiative (CCI). Read this expert medical coding insight and learn what codes for CPT apply.

CCI released version 18.0, effective Jan. 1, revealing 15,530 novel active pairs as well as 6,197 code pair terminations.

From novel skin to abdominal surgical CPT codes, ensure you comply with the following listed CCI edits when you bill new 2012 CPT codes.

Infusions, Imaging, and Anesthesia Included

Medicare states that when you bill a surgical code, the procedure includes all intraoperative services that are normal and essential parts of the surgery. That is the reason why CCI 18.0 contains thousands of novel edit pairs with the following listed 2012 CPT codes that you might use in your surgical practice this year:

· 15271-+15278 -- (Application of skin substitute graft . . . )

· 15777 -- (Implantation of biologic implant (e.g., acellular dermal matrix) for soft tissue reinforcement (e.g., breast, trunk) (List separately in addition to code for primary procedure)

· 36251-36252 -- (Selective catheter placement (first-order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image post processing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed;...)

· 36253-36254 -- (Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; . . . )

· 37191 -- (Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed)

· 37192 -- (Repositioning of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed)

· 37193 -- (Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance (ultrasound and fluoroscopy), when performed)

· 49082-49083 -- (Abdominal paracentesis (diagnostic or therapeutic); . . . )

· 49084 -- (Peritoneal lavage, including imaging guidance, when performed.)

Know the column 2 codes: With the above listed novel surgical codes in column 1, CCI 18.0 creates edit pairs with the following listed procedures that Medicare considers "column 2" (component) CPT codes:

· Venipuncture, IV, infusion, transfusion, or arterial puncture services represented by CPT codes for instance 36000, 36400-36410, 36430-36440 36600, 37202, 96360, and 96372

· Naso- or oro-gastric tube placement (43752)

· Bladder catheter placement (51701-51703)

· A lot of nerve block codes in the range 62310-64530

· Operating microscope (+69990)

· A lot of electrocardiogram (ECG) as well as electroencephalography (EEG) codes for instance CPT codes 93000-93010 and 95812-95822

· Pulmonary services for instance 94002, 94200, and 94680

· Moderate sedation codes for instance 99148-+99150.

· You must study these bundles sensibly, as CCI assigns many of the novel edit pairs a "0" modifier indicator, implying that you cannot overrule the edit pair under any situation.

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