Nurse visit usage crackdown key part of April CCI changes
December 4th, 2014 - Scott KraftBe careful when billing a nurse E/M visit (99211) along with a venipuncture blood draw (36415) or EKGs (93000-93010) starting April 1. All of these code pairs are new CCI edits subject to a bundling denial of the nurse visit, though CCI will allow you to use a modifier to bypass the edit.
These services would typically not be paid unless the nurse visit was for something other than the EKG or the blood draw. If they are for the same service, it would be considered to be double-billing.
Here are some of the additional new edits effective April 1:
- Visual screening test 99172 will be bundled into most E/M services. These edits cannot be overridden, though 99172 is not typically paid by Medicare anyway.
- A series of new edits bundles most E/M services into the following codes: Allergy testing and service codes 95115-95180. These edits may be overridden by a modifier.
- Mohs micrographic codes 17311-17313 have a bunch of new services bundled into them, including debridement codes 11010-11011, excision codes 11400-11406 and 11450-11471. These edits can be overridden with a modifier.
- Sinus incision codes 31000 and 31002 are bundled into sinus procedure codes 31040, 31090, 31225, 31230-31235 and 31287-31295. These edits may be overridden with a modifier.
- New vascular embolization and occlusion codes 37241-37244 will have solution injection codes 36468-36471 bundled into them (may be overridden with a modifier) and ablation therapy codes 36475-36478 (may not be overridden).
- There are extensive new edits in the digestive system coding area, with 43197-43202 and 43200-43205 being bundled into different variants of new esophagoscopy codes 43191-43198. These edits may not be overridden with a modifier. Also, look to new edits that bundle 43191-43198 into codes in the 43200 series, which also cannot be overridden.
- Chemodenervation codes 64642-64644 and electromyography codes 95860-95870 are bundled into chemodenervation codes 64615-64617, but most of these edits may be overridden with a modifier.
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