What Interventional Radiology Coders Should Know About CCI 15.1

Posted on 16. Apr, 2009 by Editor in Hot Coding Topics

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With 304,000 new edits Correct Coding Initiative (CCI) version 15.1 put into effect April 1, finding the ones that apply to interventional radiology is like finding the proverbial needles in the haystack. And now, slapping modifier 59 on every claim is more tempting than ever.

Careful: Many practices apply modifier 59 (Distinct procedural service) indiscriminately to bundled pairs to override the edits. But misusing modifier 59 this way is a serious compliance issue, leading to a high likelihood of audit and risking fraud charges, according to Frank Cohen, MPA, senior analyst with MIT Solutions Inc. in Clearwater, Fla., in his March 25, 2009 webinar.

Protect yourself and your practice by keeping an eye out for these edits and identifying legitimate opportunities to override them.

The Usual Suspects Take Center Stage

CCI takes aim at a few select codes this round, with only 524 unique codes listed in column 2 of the new column 1/column 2 edit list, Cohen says.

“In most cases, procedures such as injections performed during surgery would be included in the main surgical procedure anyway, so these edits shouldn’t hurt too badly,” says Heather Corcoran with CGH Billing in Louisville, Ky.

For example: CCI bundles many of the codes it focuses on into interventional procedures, such as G0392 (Transluminal balloon angioplasty, percutaneous; for maintenance of hemodialysis access, arteriovenous fistula or graft; arterial).

The column 2 codes with a modifier indicator of 1 (indicating you may override the edit with a modifier when appropriate) include:

• venipuncture: 36400-36406, 36420-36425

• push transfusion: 36440

• arterial puncture/catheterization: 36600, 36640...