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Home visit codes now bundled with lesion removal in CCI update

You'll find more than 43,000 new code pairs under the Correct Coding Initiative's latest quarterly update, and one small section stands out for providers who perform home-visit services.
Starting Oct. 1, providers that perform a single lesion removal (11055) during a home-visit encounter will need to attach modifier 25 (Significant, separately identifiable E/M service) to the home-visit E/M code -- within the range of 99324-99328 and 99341-99345 -- in order to get the claim paid.
That's because the latest CCI edits (version 22.3) bundle the eight home-visit codes into 11055 and attribute the codes pairs a "1" modifier, which means you're eligible to bill both services on the same day -- but you'll need a modifier to supersede an automatic claim denial.
The bundling of home visit codes isn't new; home-visit code 99324 is bundled into dozens of other services, including some found in the integumentary chapter of the CPT book, such as nail-debridement codes 11720 and 11721.
But the new bundle on 11055 means you'll have to pay closer attention to your claims and ensure your modifier use is accurate to realize full reimbursement for your work.
Find out more about the Oct. 1 edits, which largely target debridement services, and access the full update from CMS here:
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