So what changed?
DecisionHealth analysis uncovered 207 code pair updates in the February version, compared with the original PTP edits list issued Dec. 15. Those include seven new edits, 62 revised edits and 138 newly deleted code pairs.
Many of the changes appear to make it easier to bill for administration of other vaccines on the same date as a COVID-19 vaccination. For example, code pairs that would have bundled vaccine administration codes 90473 and G0008-G0010 as non-payable components of COVID administration code 0001A are deleted in the Feb. update.
Similarly, the update revises PTP edits that bundle established office nursing visit code 99211 as a non-billable component of COVID administration codes 0001A, 0002A, 0021A, 0022A, 0031A, 0041A and 0042A. While those code pairs are left in place, the modifier indicator for each is changed from “0” (no modifier allowed) to “1” (modifier permitted to override).
A good chunk of the February update seems to be focused on two nasopharyngoscopy codes 69705 and 69706. In February, CMS removed code pairs added in Dec. that bunded those two codes into GI endoscopies in addition to revising other PTP edits to allow 69705 and 69706 to be reported with nasal endoscopy procedures with a “1” modifier indicator.
Also, CMS added new PTP edits bundling 69705 and 69706 as components of the new Category III codes for transnasal esophagogastroduodenoscopy (0652T-0654T).
In one additional new February code pair, CCI now bundles 96127 (brief emotional/behavior assessment) as a component of 99424 (Principal care mgmt. phys 1st 30). The code pair has a “0” modifier indicator so no modifier will be permitted to override it.
One additional observation: December code pair deletions for nasopharyngoscopy codes 69705-69706 and anesthesia codes 01937-01942 are not included in the February update. Anesthesia practices that bill for both of those code series should keep an eye out for new denials related to this change.
Here are those December code pair deletions that did not make it into the February CCI version. The edits have a modifier indicator of "1" so a modifier is permitted to override them when warranted:
|
Column 1 Code
|
Description
|
Column 2 code
|
Description
|
|
01937
|
Anes drg/aspir crv/thrc
|
69705
|
Nps surg dilat eust tube uni
|
|
01937
|
Anes drg/aspir crv/thrc
|
69706
|
Nps surg dilat eust tube bi
|
|
01939
|
Anes nulyt agt crv/thrc
|
69705
|
Nps surg dilat eust tube uni
|
|
01939
|
Anes nulyt agt crv/thrc
|
69706
|
Nps surg dilat eust tube bi
|
|
01940
|
Anes nulyt agt lmbr/sac
|
69705
|
Nps surg dilat eust tube uni
|
|
01940
|
Anes nulyt agt lmbr/sac
|
69706
|
Nps surg dilat eust tube bi
|
|
01941
|
Anes neuromd/ntrvrt crv/thrc
|
69705
|
Nps surg dilat eust tube uni
|
|
01941
|
Anes neuromd/ntrvrt crv/thrc
|
69706
|
Nps surg dilat eust tube bi
|
|
01942
|
Anes neuromd/ntrvrt lmbr/sac
|
69705
|
Nps surg dilat eust tube uni
|
|
01942
|
Anes neuromd/ntrvrt lmbr/sac
|
69706
|
Nps surg dilat eust tube bi
|
Source: DecisionHealth based on CMS data