CCI Edits 16.3: Include Wound Repair In Free-Flap Grafts or Risk Denials

The latest CCI edits 16.3 that went into effect on October 1 this year creates a

coding bundle naming simple wound repair codes 12001-12007 and 12041-12047 as intrinsic components of 15756, 15757, 15758.

What does this mean? In the above pairings, CCI lists the wound repair codes as column 2 codes, which means they are considered components of the comprehensive codes (15756-15758) under Column 1.

Do not miss: These bundles have a modifier indicator of one; as such you may use a modifier like 59 to override the edit if the clinical circumstances merit separate reimbursement like a separate encounter on the same date, a separate anatomical site or a separate indication.

Catch this debridement/site prep bundle

The latest CCI edits addresses another aspect of your skin graft coding with a new edit bundling 11040 as a component of 15002. This edit indicates that Medicare considers debridement to be an essential component of site prep procedures. But CCI has also marked these bundles with modifier indicator 1 so you may report 11040 along with 15002 or 15004 under appropriate clinical circumstances with an appropriate modifier.

New edits target hematoma, nail repair

From October 1, CPT code 11740 includes 11730. As with other CCI edits, these bundles are marked with modifier indicator '1', allowing separate reporting if clinically necessary, with the right modifier appended to the component (column 2) code.

These would not be used together on the same site. They would have to be carried out on different nails.

For more on the latest CCI edits, sign up for a one-stop Medical Coding website. Such a site comes with a CCI Tools that tells you whether CCI bundles a code combination and if the edit allows a modifier, among a host of other information pertaining to CCI edits.

CCI Edits 16.3: Include Wound Repair In Free-Flap Grafts or Risk Denials

By: James Smith

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