So does your ophthalmology practice bill for anesthesia injections along with endothelial keratoplasty (EK) procedures? If so, with effect from April 1 this year, you need to think before you code, as per CCI 17.1.
Non-mutually exclusive (NME) edits apply to services that a doctor might carry out during the same care session however that are not billable together. This is because one of the codes (the Column 2 or component code) is included in the services represented by the Column 1 (comprehensive) code of the pairing. You can bill individual components if the doctor doesn't carry out the whole comprehensive procedure.
However if the doctor carries out the entire (comprehensive) procedure, you need to bill the comprehensive code in place of the individual parts or components.
Bundle anesthetic agent injections into EK code
CCI adds several new bundled codes. Now code 65756 (Keratoplasty [corneal transplant]; endothelial?) includes almost all of the “Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic" codes (64400-64530). CCI marks most of these bundles with modifier indicator “0', which prevents you from reporting the bundled codes separately under any circumstances, even with a proper modifier.
Apart from these, the latest CCI also bundles codes such as 36400-36406, 36420-36425 into 65756:
Watch for Aqueous Drainage Bundles
The latest edits also declares CPT codes 66170, 66172, and 66180 mutually exclusive with 0253T. CCI had already declared 66170, 66172, and 66180 to be mutually exclusive with similar CPT Category III (temporary) codes 0191T and 0192T.
Anterior segment aqueous drainage devices (say for instance the iStent Trabecular Micro-Bypass Stent) inserted internally or externally without an extraocular reservoir are a new treatment many ophthalmologists are utilizing as a method to reduce intraocular pressure for the treatment of glaucoma. But then many insurers take these devices investigational and not medically necessary.
For your information: According to Frank Cohen, MPA, MBB, senior analyst for The Frank Cohen Group in Clearwater, Fla., CCI 17. 1 has 709,527 active edit pairs. For the latest on this, go to www.cms.gov to ensure you correctly report procedures.
Non-mutually exclusive (NME) edits apply to services that a doctor might carry out during the same care session however that are not billable together. This is because one of the codes (the Column 2 or component code) is included in the services represented by the Column 1 (comprehensive) code of the pairing. You can bill individual components if the doctor doesn't carry out the whole comprehensive procedure.
However if the doctor carries out the entire (comprehensive) procedure, you need to bill the comprehensive code in place of the individual parts or components.
Bundle anesthetic agent injections into EK code
CCI adds several new bundled codes. Now code 65756 (Keratoplasty [corneal transplant]; endothelial?) includes almost all of the “Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic" codes (64400-64530). CCI marks most of these bundles with modifier indicator “0', which prevents you from reporting the bundled codes separately under any circumstances, even with a proper modifier.
Apart from these, the latest CCI also bundles codes such as 36400-36406, 36420-36425 into 65756:
Watch for Aqueous Drainage Bundles
The latest edits also declares CPT codes 66170, 66172, and 66180 mutually exclusive with 0253T. CCI had already declared 66170, 66172, and 66180 to be mutually exclusive with similar CPT Category III (temporary) codes 0191T and 0192T.
Anterior segment aqueous drainage devices (say for instance the iStent Trabecular Micro-Bypass Stent) inserted internally or externally without an extraocular reservoir are a new treatment many ophthalmologists are utilizing as a method to reduce intraocular pressure for the treatment of glaucoma. But then many insurers take these devices investigational and not medically necessary.
For your information: According to Frank Cohen, MPA, MBB, senior analyst for The Frank Cohen Group in Clearwater, Fla., CCI 17. 1 has 709,527 active edit pairs. For the latest on this, go to www.cms.gov to ensure you correctly report procedures.
