Bundle Up With CCI Edits Updates

CCI 22.0 5 Subtle Ob-Gyn Bundles Highlight Quarter 1 CCI Edits , cci edits updates, ob-gyn cci updates, ob-gyn

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.

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 you’re more used to seeing—the classic type that bundles services together for a single payment. Let’s 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 can’t 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 in the comment box below.

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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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