Coding Edits: Pay Attention to the Newest CCI Pairs for Pain Management

Thu, Jun 23, 2016 --

Coding Updates

Anesthesia Billing, Anesthesia Side Effects, Side Effects Of Anesthesia, Effects Of Anesthesia, anesthesia cpt codes, side effects of epidural, Ncci Edits, Ncci Codes, National Correct Coding Initiative, Cci Indicator, Medicare Ncci Edits

The April set of National Correct Coding Initiatives (NCCI) edits includes so many edits affecting anesthesia and pain management that you would do better learning and using the exceptions rather than the applicable edits themselves.

Learn These Intravenous Infusion Codes

All the pain management codes included in the April (CCI 22.1) edits are considered the most comprehensive, or “Column 1,” code when paired with the following IV infusion procedures, which are the component services already covered by that comprehensive code, also called the “Column 2” codes:

  • +96361, Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)
  • +96366, Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
  • +96367, … additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure).
  • +96368, … concurrent infusion (List separately in addition to code for primary procedure).

With the above-listed column 2 codes, you would report the pain management procedure, such as 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]), or the anesthesia-related procedure, such as 93503 (Insertion and placement of flow directed catheter [e.g., Swan-Ganz] for monitoring purposes), if the procedure was performed during the same encounter as any of the four IV infusion codes above.

Each of the edit pairs noted above carries a modifier indicator of “1,” which means that you might be able to unbundle the pair to report both, if your clinician’s documentation supports it. If this is the case, append a modifier such as 59 (Distinct procedural service) to the column 2 code, in this case our four IV infusion codes.

Notice the Exceptions to the Edit Rules

The CCI 22.1 edits bundle add-on IV infusion codes into just about every procedure in CPT®, but there are still some services that you can report without having to append a modifier to unbundle an edit. For example, “unlisted” codes, such as 64999 (Unlisted procedure, nervous system) are not included in the edits, which makes sense because the unlisted codes can cover so many different services.

You’ll notice that add-on codes including codes for procedures of vertebroplasty and kyphoplasty, transforaminal epidural injections, paravertebral facet joint injections, and destruction of paravertebral facet joint nerves are missing from these infusion CCI edits, but don’t celebrate too soon. Check CCI edits for the relevant primary code first. In many cases, CCI created a bundle for the primary code, and if you can’t report the primary code, then you can’t report the add-on code either.

How About You?

Have you had great success unbundling CCI edits? We’re interested in your experience. Tell us about it in the comment box below.

In Pain Management? You Need This Resource

Neurology and Pain Management Coding Alert is the monthly guide full of tips, strategies, and guidelines for accurate pain management coding and neurology claims reimbursement — including everything from facet joint injections to EEG recording and more. Download a free sample issue today!



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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