44950, 44970 Appendectomies Go Through More Restrictions Under CCI 17.3

CMS reverses some venipuncture as well as catheter placement edits.

Your general surgeon might remove a patient's appendix in another laparoscopic or open abdominal surgery -- but don't presume that you will get payment for the appendectomy, according to the new edit pairs included in the latest Correct Coding Initiative (CCI) update.

CCI version 17.3, which took effect Oct. 1, proposes 1,380 new edit pairs as well as 835 terminated bundles. Let us help you peer through the numbers to learn the CCI edits changes that will influence your general surgery practice.

Expand Appendectomy Billing Restrictions

Before CCI 17.3, CMS already bundled lap appendectomy (44970, Laparoscopy, surgical, appendectomy) as the column 2 (component) code to multiple procedures from the surgical laparoscopy CPT® divisions for esophagus, stomach, bariatric surgery, intestines, rectum, liver, billiary tract, as well as abdomen. These CCI edits all illustrate a modifier indicator of "1," implying that you can overrule the edit pairs when circumstances permit.

Tip: To avoid inappropriately "double dipping" laparoscopic surgery claims, you should always check CCI edits before you bill multiple scopes.

17.3 adds appendectomy bundles: In CCI 17.3, you'll find 44970 bundled into most surgical codes -- open or laparoscopic -- including the pelvic region. That involves bundles from splenectomy (38100-38120), to proctopexy (45400-45402), and beyond.

Similarly, CCI edits now bundles the surgical appendectomy codes 44950-44960 (Appendectomy . . . ) into a lot of further pelvic surgeries. Even though the open appendectomy edits are not as huge as those affecting laparoscopic appendectomies, you must get acquainted with the bundles to side-step denials for your surgery practice.

Watch '0' modifier indicator: You can't unbundle the new appendectomy edits with a modifier (such as 59, Distinct procedural service) under any situation. CMS specifies the constraint by placing a "0" modifier indicator on the approximately 500 novel appendectomy code pairs.

Relax Venipuncture/Catheter Constraints

CCI 17.3 repeals almost 80 long-standing edit pairs that limit how you code venipuncture, venous as well as arterial catheter placement, and also transfusion procedures.

Caution: Don't inevitably make an adjustment to your coding habits and "unbundle" these services repeatedly. Even devoid of the edit pairs, you'll need to make certain that your surgeon's documentation supports billing distinct procedures.

The aim for this CCI edits change is blurred, but you should carry on tofollow coding conventions, for instance routinely bundling arterial catheterization codes (36215-36247, Selective catheter placement, arterial system; . . . ) into a lot of services that take account of an arterial approach.

The above expert CCI edits information is brought to you by SuperCoder.com. Click here to read the whole article and have more accurate and profitable expert Medical Coding advice: http://www.supercoder.com/articles/articles-alerts/gca/cci-edits-44950-44970-appendectomies-catch-more-restrictions-under-cci-17.3-108527/

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