2014 brings big volume of changes to CCI edits

Expect the biggest set of CCI changes you’ll see in 2014 to take effect on Jan. 1, as the edits are synched up to CPT® and HCPCS code changes that start next year.

There are 61,120 new edit pairs coming next year, along with 13,107 deletions and 137 modifier changes.

Many of the new edits won’t impact your billing decisions – at least not yet. There are four new E/M codes next year – 99446-99449 – to be used for billing phone consultations based on the length of the consultation.

Though those codes have a “B” status indicator in the 2014 final fee schedule, which means they’re always bundled anyway, a large number of the new edits coming in January bundle those codes into other services. Looks like Medicare, which traditionally pays for very few non face-to-face encounters, is serious about making sure that it does not pay for these.

Here are some new edit pairs to look for in January:

• New CPT® code 10030, image-guided fluid drainage by catheter, will have hundreds of codes bundled into it, including integumentary repair codes (11055-13153), Unna boot and strapping codes (29580-29582), venipuncture codes (36000-36640), injection codes (62310-62319 and 64400-64530) and a number of medicine and E/M codes. Most of these edits may be overridden with a modifier – the injection code edits cannot. Conversely, 10030 is bundled into a number of musculoskeletal codes.
• Transitional care management codes 99495 and 99496 are bundled into hundreds of codes across the CPT® spectrum, duplicating many of the edits involving the phone consultation visits noted above. Most of these edits may not be overridden with a modifier.
• New breast biopsy and placement codes 19081-19086 has a slew of integumentary codes in the 12000 series bundled into it, as well as the injection codes noted in the new edits for 10030. Most may be overridden with a modifier when appropriate, with the exception of the placement codes and the injection code pairs. Many of these edits also apply when 19271-19288 the primary code. 19271-19272 are chest excision codes, the 19281-19288 series are breast placement device codes.
• Osteotomy codes 22220-22224 have bone marrow aspiration code 38220 and harvesting code 38230 bundled into them. These edits may not be overridden with a modifier. Vertebroplasty codes in the 22500 series are also impacted by these edits.
• Three new foreign body removal codes (23333-23335) have a number of other codes from the musculoskeletal system bundled into them, as well as injection codes from the 64400 series noted above and most E/M codes. Few of these edits can be overridden with a modifier.
• Eight newly created transcatheter aortic valve replacement codes (33361-33369) are the subject of numerous edits. Bundled into them are thoracostomy codes 32551-32557, a handful of catheterization codes in the 36000 series, and aortagrophy and angiography codes in the 75000 series. Most of these may be overridden with a modifier. 33366 also has edits with a number of integumentary repair codes and E/M services.
• New esophagoscopy code 43229 has a number of services bundled into it, notably integumentary repair codes, most injection codes and E/M services. Most can be overridden with a modifier, but not the injection edits. Most of these edits will also apply to new flexible EGD code 43233 and new imaging codes between 43253-43278 as well.
• Newly added chemodenervation codes 64616 and 64617 will have most of the injection codes and E/M services bundled into them, as well as medicine codes in the 93000 series. The majority of these edits may be overridden with a modifier.