Massive National Correct Coding Initiative (CCI) Edit Changes
by SVT Reimbursement Advisor Frank West, RN BSN RVT FSVU

11/30/00—Roughly 57,000 code bundling edit changes took effect on 10/30/00 with the release of CCI version 6.3. This is compared to "only" 8,000 changes in CCI 6.2 or the 14,000 changes in CCI 6.1. The majority of the changes specific to vascular diagnostic studies deal with the bundling of the majority of Evaluation and Management (E/M) procedure codes (i.e., CPT codes 99201 through 99357) with every noninvasive vascular study procedure code (i.e., CPT codes 93875 through 93990). Furthermore, almost every diagnostic ultrasound procedure code and echocardiography procedure code is similarly bundled, as are large numbers of other procedures (many lab, radiology, physical therapy, pulmonary services, etc. codes).

The impact: if a physician performs and documents an appropriate E/M
procedure and a noninvasive vascular diagnostic procedure on the same date of service, payment for the E/M procedure will be denied as being a
"component" of the "comprehensive" diagnostic procedure UNLESS the E/M procedure code is submitted with a "-25" modifier. The "-25" modifier is defined as "Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service."

Obviously, it is now critical that physicians' office coding personnel are
aware of these edits and the appropriate use of the various modifiers.

CCI Version 6.3 Comprehensive Code Edits Noninvasive vascular CPT codes (93875 - 93990)