June 2007

E/M, Digestive Surgery Codes Top List of CCI edits
E/M Tip of the Month
Take Your Exam Online
Upcoming Events

Hello from the Board of Medical Specialty Coding! We hope you enjoy your monthly ezine and find the information useful. If you have any comments or recommendations for future issues, please contact me through the following channels:

Victoria Forlini, Executive Director
vforlini@medicalspecialtycoding.com
301/287-2250 (phone)
301/287-2941 (fax)

E/M, Digestive Surgery codes top list of CCI edits

Many of the 1,692 newly-bundled code pairs in Correct Coding Initiative (CCI) version 13.1, effective April 1, involve gastric bypass, colectomy and other digestive procedures. You’ll also find Category III codes 0115T and 0116T for medication therapy management by a pharmacist bundled into most E/M codes. And orthopedic practices will want to watch out for total disc arthroplasty edits.

Interestingly enough, CCI 13.1 also includes new edits that prevent you from billing certain combinations of E/M codes together – edits that can’t be over-ridden with a modifier.

[CCI refresher: Medicare only pays for the Column 1 code of each code pair edit. The Column 2 code is considered “bundled into” the Column 1 code. In addition, each edit has a modifier indicator of either “1” or “0.” Modifier indicator “1” means that you can override the bundling edit by using an appropriate modifier (usually, but not always, modifier 59). Modi-fier indicator “0,” on the other hand, means you can’t break the edit even by using a modifier.]

The E/M edits bundle lower-level E/M codes into the higher-level codes of the same category, all with modifier indicator “0.”(By “category,” we mean new patient office visits, established patient office visits, initial hospital care, subsequent hospital care, etc.) However, it seems unlikely you would bill for more than one code in each category for the same patient on the same day.

For example: 99201 is bundled into Column 1 code 99202; 99201 and 99202 are bundled into Column 1 code 99203; 99201-99203 are bundled into Column 1 code 99204; and 99201-99204 all are bundled into Column 1 code 99205.

You won’t find these types of edits for established patient office visit codes 99211-99215 or office consult codes 99241-99245. In addition to the new patient office visits, they only show up for these code categories: initial observation care 99218-99220; initial and sub-sequent hospital care 99221-99233; inpatient consultations 99251-99255; new and established patient rest home care 99324-99337; and new patient home ser-vices 99341-99345.

Gastric bypass codes 43770-43774 are also heavily represented in the new edits. Unlike the E/M codes, most – but not all – of these edits can be overridden with an appropriate modifier. The majority of the gas-tric bypass edits are with gastrostomy code 43653, laparoscopy codes 44180 and 58660, and gastric restriction codes 43887 and 43843-43847. A number of colectomy and laparoscopy codes also gain new edits. Some other edits to note:

• Total disc arthroplasty codes 22857-22865, 0090T, 0093T and 0096T see edits with spine osteotomy, arthrodesis and discography procedures.
• Various tetanus and diphtheria vaccination codes 90700-90721 gain edits with other tetanus/diphtheria vaccine codes in the same range.
• Injection code 90772 is bundled into Column 1 code 90774 (IV push).
• Lesion injection codes 11900 and 11901 are bundled into Column 1 chemotherapy codes 96401-96450 and 96542.

Only 299 edits were marked for deletion in CCI 13.1. Many of the deleted edits involve Column 1 nervous system codes 61105-61867 paired with Column 2 stereotactic radiation treatment delivery codes 77371-77373.

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E/M Tip of the Month
Test your E/M coding skills by identifying the answer to this question:

May the request for an opinion be verbal?

Find out the answer at the bottom of this email newsletter. Also check this space monthly for the E/M Tip of the month.

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Take Your ACS or SCP Exam Online

To make test-taking easier for you, you can now take the ACS and SCP certifications and ACS recertification exams online. It's simple! Register as you normally would -- via our website or on paper, and select the Online option. We will send you an email confirming your registration and giving you further instructions. Don't worry! You still can take the exam at a conference, but we're listening to you as you search for easier ways to become certified.

Visit us at www.medicalspecialtycoding.com for more information.

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Upcoming Events

Here's the 411 on some upcoming events where you'll get top-notch educational opportunities to earn CEUs and even a place to sit for your specialty certification or recertification exam!

Conference of the Month:

Advanced Orthopedic Coding Symposium

Orthopedic coding and reimbursement professionals are invited to participate in a true “soup to nuts” program that covers all the processes -- from scheduling to E/M and surgical coding to denials management -- with lessons to improve each.

The program agenda is available online at www.specialtyconferences.com/ortho2007 and is divided into 2 sections: Fundamentals of the Orthopedic Billing Process and Advanced Surgical Coding from Shoulders to Toes.

Check out more in-person and audio conference opportunities:

Event: Critical Care: Tips for Better Documentation
Date: July 10, 2007, 12:00-1:30 p.m.
To register or to learn more information:
http://www.decisionhealth.com/conferences/A1261/home.html

Event: Straighten Up Your Spine Coding
Date: July 11, 2007, 1:00-2:00 p.m.
To register or to learn more information:
http://www.decisionhealth.com/conferences/A1148/home.html

Event: Manage Collections & Find Answers When Doctors Ask About Revenues
Date: July 17, 2007, 1:00-2:30 p.m.
To register or to learn more information:
http://www.decisionhealth.com/conferences/A1269/home.html

Event: Correct Coding for Interventional Procedures: The Basics
Date: July 18, 2007, 1-2:30 p.m.
To register or to learn more information:
http://www.decisionhealth.com/conferences/A1252/home.html

Event: Advanced Orthopedic Symposium
Date: July 18-20, 2007
To register or to learn more information:
www.specialtyconferences.com/ortho2007/index.html

Event: Conquer Coding and Billing for Physician Services Outside of the Office
Date: September 17-18, 2007
To register or to learn more information:
http://www.specialtyconferences.com/outside/index.html

Event: Billing and Coding Pain Management
Date: October 10-12, 2007
To register or to learn more information:
http://www.decisionhealth.com/conferences/pain2007/index.html

Event: Improve Billing, Coding and Profitability for Freestanding ASCs
Date: October 15-16, 2007
To register or to learn more information:
http://www.specialtyconferences.com/asc/index.html

Event: Medical Practice Management Summit 2007
Date: November 12-14, 2007
To register or to learn more information:
http://www.decisionhealth.com/conferences/summit2007/

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Answer to the E/M Tip of the Month is...

Yes, but both the requesting and consulting providers must document the verbal interaction identifying the request and reason for a consult in the medical record.

Source: http://www.cms.hhs.gov/MLNMattersArticles/
downloads/MM4215.pdf