Include Wound Repair In Free Grafts To Stay Away From Denials
Do you often code separately for wound repair when your dermatologist carries out a free-flap graft procedure
? If so, you need to watch out as the latest CCI 16.3 will have you changing this habit soon.
The new revision, that went into effect on October 1, creates a coding bundle naming simple wound repair codes 12001-12007 and and 12041-12047 as intrinsic parts of
15756 -- Free muscle or myocutaneous flap with microvascular anastomosis
15757 -- Free skin flap with microvascular anastomosis
15758 -- Free fascial flap with microvascular anastomosis. 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 more comprehensive codes under Column 1. Medicare and other private payers who follow Medicare payment rules will not pay for two bundled codes billed for the same patient on the same day; payers will not pay for the Column 2 code and reimburse only for the Column 1 code.
Do not miss: These bundles have a modifier indicator of '1'. As such, you may use a modifier like 59 to override the edit if the clinical circumstances warrant deparate reimbursement like a separate encounter on the same date, a separate anatomical site or a separate indication.
For more on the latest CCI edits and other medical billing training, sign up for a one-stop medical coding website. Such a site comes with a CCI Tool that tells you if CCI bundles a code combination and if the edit allows a modifier. In fact, you can stay tuned to the latest on CCI edits by signing up for this one-stop medical coding website.