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Edition Version
Latest CCI Edits Highlight Pulmonary Rehab With Mutually and NME Edits
Do you have to commonly report pulmonary rehab code G0424? If so, you need to pay attention to the latest CCI edits version 16.3, which went into effect on October 1 this year. Three of the 33 just-in mutually exclusive pairs concern pulmonologists, while non-mutually exclusive edits include 150 bundles representing pulmonary rehab.
Highlight these ME pulmonary rehab pairs
In the latest CCI edits, only three ME edits should impact pulmonologists. ME edits mean the code pair represents procedures or services that could not reasonably be carried out at the same session by the same provider on the same beneficiary. Medicare will only pay you for the lesser-valued of the two procedures.
The just-in comprehensive pulmonary rehab (PR) code G0424 (Pulmonary rehabilitation, including exercise and monitoring, per hour, per session) is mutually exclusive with the three older PR codes: G0237, G0238, G0239.
Pulmonary rehab services are mutually exclusive of respiratory therapy services that can be included as part of the pulmonary rehab session.
Note: CCI assigns a modifier indicator of '0' to all of these edit pairs, which means you cannot override the edit by reporting the right modifier (like modifier 59, distinct procedural service). In a nutshell, you cannot report the procedures together under any circumstances.
What modifier indicator '1' means
Furthermore, the latest CCI edits categorize G0424 as a comprehensive non-mutually exclusive bundle of the following component codes in physical medicine and rehabilitation.
Laboratory procedures and interpretation of test results, such as 94010, 94200 and 94680, physical/occupational therapy (re)evaluation, such as 97001-97004, therapeutic procedures, such as 97110 and 97530, Tests and measurements, such as 97750.
What's more, medical nutrition therapy codes (97802-97804) are a component of the procedure G0424. Pulmonary rehab includes physician-prescribed exercise, education and training, psychosocial assessment, outcome assessment, and all monitoring carried out on the same day.
Remember: Non-mutually exclusive edits pair codes for two services that doctors often carry out during the same session. CCI lists one code as the comprehensive procedure which means it is considered the larger procedure and the second code as the component which is a piece of the comprehensive. All non-mutually exclusive edits for pulmonology carry a "1" indicator – with the exception of 94667, 94668 and 94770 which carry an indicator of '0'.
Bundles with a '1' indicator means you can report both procedures of a pair in certain, although unlikely circumstances. These circumstances cover performing the procedures at separate sessions on the same day.
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We provide you simple, instant connection to official code descriptors & guidelines and other tools for 2010 CPT code, HCPCS lookup that help coders and billers to excel in the work they do every day.
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