CCI 18.0 Update: 67961-67966 Contains Graft Site Preparation
Also: Look for these novel eyelid reconstruction Correct Coding Initiative edits.
In case your ophthalmic surgeon carries out eyelid repairs and reconstructions, heads up. The Correct Coding Initiative requires ensuring you're paying attention to CPTÃ?âEUR? definitions -- and in case you're not, you could risk denials. Read this expert medical coding insight and know how CCI edits change your selection of codes for CPT
CCI came out with version 18.0, effective Jan. 1, disclosing 15,530 new active pairs and 6,197 code pair deletions
Of main concern to ophthalmology coders are the bundles that affect eyelid excision as well as repair codes 67961 (Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin) along with 67966 (... over one-fourth of lid margin). As per CCI, these codes for CPT are currently bundled with 15004 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar [including subcutaneous tissues], or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/ or multiple digits; first 100 sq cm or 1% of body area of infants and children).Rationale: Medicare is clarifying CPTâEUR?'s definition of these distinct eyelid repair and excision procedures. CCI has bundled code 15004 as a "Column 2" code into the "Column 1" codes 67961-67966, which implies that Medicare considers 15004 to be an essential part of the 6796x procedures. Remember that the code definition for 67961- 67966 includes the phrase "may include preparation for skin graft, specifying that preparation for the graft is taken as a part of the surgeon's work represented by these codes for CPT.Include Pedicle Formation, Flap Delays in Lid Reconstructions CCI Edit 18.0 furthermore bundles codes 15576 (Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral) and 15630 (Delay of flap or sectioning of flap [division and inset]; at eyelids, nose, ears, or lips) into 67971- 67975 (Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid... ).Unbundling opportunity: These bundles are all marked with modifier indicator "1," which may let you to break the bundle. In certain clinical conditions you can override -- not ignore -- CCI edits and receive separate payment for bundled codes for CPT. To discover if you can distinctly bill services, first check the "modifier indicator" in column F of the CCI spreadsheet.
In case your ophthalmic surgeon carries out eyelid repairs and reconstructions, heads up. The Correct Coding Initiative requires ensuring you're paying attention to CPTÃ?âEUR? definitions -- and in case you're not, you could risk denials. Read this expert medical coding insight and know how CCI edits change your selection of codes for CPT
CCI came out with version 18.0, effective Jan. 1, disclosing 15,530 new active pairs and 6,197 code pair deletions
Of main concern to ophthalmology coders are the bundles that affect eyelid excision as well as repair codes 67961 (Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin) along with 67966 (... over one-fourth of lid margin). As per CCI, these codes for CPT are currently bundled with 15004 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar [including subcutaneous tissues], or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/ or multiple digits; first 100 sq cm or 1% of body area of infants and children).Rationale: Medicare is clarifying CPTâEUR?'s definition of these distinct eyelid repair and excision procedures. CCI has bundled code 15004 as a "Column 2" code into the "Column 1" codes 67961-67966, which implies that Medicare considers 15004 to be an essential part of the 6796x procedures. Remember that the code definition for 67961- 67966 includes the phrase "may include preparation for skin graft, specifying that preparation for the graft is taken as a part of the surgeon's work represented by these codes for CPT.Include Pedicle Formation, Flap Delays in Lid Reconstructions CCI Edit 18.0 furthermore bundles codes 15576 (Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral) and 15630 (Delay of flap or sectioning of flap [division and inset]; at eyelids, nose, ears, or lips) into 67971- 67975 (Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid... ).Unbundling opportunity: These bundles are all marked with modifier indicator "1," which may let you to break the bundle. In certain clinical conditions you can override -- not ignore -- CCI edits and receive separate payment for bundled codes for CPT. To discover if you can distinctly bill services, first check the "modifier indicator" in column F of the CCI spreadsheet.
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