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Bundle Up With CCI Edits Updates

By Susan Dooley

Bundling of payments this is a trend you can expect to see continue to grow, with effects on a wider
array of services. Many physicians have experience with bundling in the form of global surgery periods
or global payments for obstetrical care. In a newer wrinkle of bundling, called a bundled payment
methodology, a single bundled payment covers services delivered by two or more providers during an
episode of care or over a specified period of time. For example, say a patient has coronary artery bypass
grafting (CABG) surgery. The payer would make a single combined payment for that episode of CABG,
rather than making one payment to the hospital, another to the surgeon, and a third to the
anesthesiologist. This bundled payment might be paid to a single entity, such as an accountable care
organization (ACO), which would then piece out the payments to the participating providers. In the
absence of an ACO, virtual bundling may be used instead, where the payer pays the providers
individually but according to prenegotiated, defined rules, so that all the provider payments together do
not exceed the previously agreed upon bundled payment amount.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

Check Out Ob-Gyn CCI Updates for Quarter 1


The Centers for Medicare and Medicaid Services (CMS) quarterly Correct Coding Initiative (CCI) edits
update, Version 22.0, took effect on Jan. 1, 2016. These are the type of bundled payments youre more
used to seeingthe classic type that bundles services together for a single payment. Lets take a look at
some of the CCI edits updates that ob-gyn practices should heed.

Thoracic Paravertebral Block Gets Bundled Into Procedures


The new edits include bundling into 56405 (Incision and drainage of vulva or perineal abscess) the work
represented by the following codes:

61650, Endovascular intracranial prolonged administration of pharmacologic agent(s) other than


for thrombolysis, arterial, including catheter placement, diagnostic angiography, and imaging
guidance; initial vascular territory
64461, Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes
imaging guidance, when performed)
64463, Paravertebral block (PVB) ; continuous infusion by catheter .

The above three codes are now column 2 codes to pretty much all of the 56xxx to 59xxx female genital
system codes. As you recall, with CCI edit pairs, the Column 1 code represents the more significant
procedure or service when reported with the Column 2 code. Column 1 codes usually have a higher
work relative value unit (RVU) than do the column 2 codes. In the case of the PVB codes (64461 and
64463), the bundles have a 0 modifier indicator, which means you cant append a modifier to those
codes to unbundle them.

New Code 0404T Gets a CCI Edit


CPT added a new code for 2016, 0404T (Transcervical uterine fibroid[s] ablation with ultrasound
guidance, radiofrequency), which got its own CCI edit in January as well. Code 0404T is now a mutually
exclusive column 2 code to 58561 (Hysteroscopy, surgical; with removal of leiomyomata). The modifier
on this edit is 1, though, which means you can apply a modifier to separate the edit if you have
supporting documentation. A good reason for separating this would be pretty rare, though an
example of a procedure that would qualify for this modifier is a completed initial hysteroscopic removal
of a fibroid, followed by radiofrequency on a separate fibroid, which is a somewhat unusual combination
of procedures.

Got CCI Edit Tips?


CCI edits can be complicated. Do you have any tips for dealing with them successfully? Let us know.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

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Enterprise Contact Person:


Name: Sam Nair
Title: Associate Director Enterprise Practice
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813


The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com