decisionhealth Newsletters, Coder Pink Sheets - 2017 Issue 10 (October)
New coding guidance: MUEs pierce joint injection services; CCI edits drug screens, critical care
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Article Overview
This article reviews a recent set of CMS coding edit updates, including medically unlikely edit revisions and Correct Coding Initiative changes. It is aimed at coders, billing staff, and compliance-focused practices that report joint injection services, definitive drug testing, laboratory services, emergency department visits, or critical care. The article covers the affected code families, the timing of the changes, and the general impact of the edit updates without replacing the full guidance.
Why This Topic Matters
These updates can affect claim processing, bundling edits, and denial management for several commonly reported outpatient and laboratory services. Understanding the scope of the changes helps practices review reporting workflows and prepare for potential payment impacts.
Article Sections
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Overview of MUE and CCI updates
Introduces the scope of the CMS update cycle and identifies the broad service areas affected. It also notes the effective timing of the changes.
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Joint injection MUE changes
Summarizes the portion of the update affecting joint injection reporting and appeals related to higher utilization. The section focuses on the impacted procedure family and the edit revision.
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Definitive drug testing code update
Covers the addition of a newer definitive drug test code and its related edit status. It also places the code in the context of the broader definitive drug testing family.
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CCI 23.3 drug screen bundling edits
Describes the update to bundled laboratory and drug screen edit pairs involving definitive drug testing and related lab services. The section also notes modifier-related edit indicators at a general level.
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Critical care and emergency department edit revision
Reviews the revised bundling relationship between emergency department services and critical care. It addresses the general effect of the edit indicator change.
What You Will Learn
- Which CMS edit programs are discussed in the update
- Which broad service categories are affected by the revisions
- How the article frames the timing and scope of the change set
- What types of lab and outpatient services are included in the bundling review
- Which parts of the update are relevant to denial management and claims review
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance teams
- Laboratory billing personnel
- Emergency department coding staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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