CCI 16.3 Edits: 0228T, 0230T Play Big Role This Time

CCI 16.3 Edits: 0228T, 0230T Play Big Role This Time

With the latest CCI edits 16.3 going into effect on October 1, this year, there are a slew of pairings involving new Category III 'T' codes for transforaminal epidural injections.

The edits affecting family physicians cover two of these just-arrived codes:

0228T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level

0230T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level. The new Category III codes 0228T-0231T have added the addition of ultrasound guidance to transforaminal epidural injections. This will eliminate the requirement to code the ultrasound independently. The current, Category I codes for transforaminal epidural injections of anesthetic and/or steroids (64479-64484) include only the injection itself. Even though the family physicians might not administer transforaminal epidurals every day, medical coders should always keep up with changes that might cross their desks. One should keep reading for the scoop on procedures one cannot report with 0228T or 0230T. No breakage: The rationale behind the just-in bundling edits falls to 'standards of medical/surgical practice. Most edits carry a modifier indicator of '0', meaning you cannot break the edit with a modifier and report both codes during a single encounter. Check possibility of work exam with psych test A small group of edits this time pair 99455 (Work related or medical disability examination by the treating physician ) with psychodiagnostic assessments 96101-96105 and neuropsychological or standard cognitive performance tests 96118-96125. The good news is that the edits involving 99455 carry a modifier indicator of '1'. A '1' modifier indicator means you can use both codes under certain circumstances and with enough supporting documentation. You will need to append one of the CCI-associated modifiers (like modifier 59, Distinct Procedural service) to the Column 2 code. The modifier unbundles the edit and allows payment for both services. To get the latest updates on the CCI edits, check out the CMS website or sign up for a medical coding guide like Supercoder.

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