The latest version of the CCI edits 16.3 that went into effect on October 1, wastes no time incorporating procedure codes you won't see in CPT until 2011. Four new codes appear repeatedly through the edits: 0228T, 0229T, 0230T, 0231T.
A bit tricky here: Some edits classify 0228T-0231T as the Column 1 or comprehensive code of the pairings; however others denote 0228T- 0231T as the Column 2 or comprehensive code. Always double check which code you should use for specific edit pairs.
Do not report anesthesia with transforaminal
CPT's anesthesia section covers two codes for anesthesia during nerve blocks – 01991 and 01992. CPT notes steer you away from reporting 01991 or 01992 with moderate sedation services. Now the latest CCI 16.3 clarifies that 01991 and 01992 are covered in the service of 0228T-0231T.
The edits carry a '0' modifier indicator, which means you cannot break the edit and report both codes during a single encounter.
Many anesthesia procedures cover 0228T, 0230T
Other edits from CCI 16.3 list 0228T and 0230T as components of multiple anesthesia codes. For instance, all forearm, wrist, and hand anesthesia codes cover the services of 0228T and 0230T. The same holds true for radiological, burn excision/debridement and obstetric procedures.
Checkpoint: Many of the edits carry a '0' modifier indicator; however some carry a '1' modifier indicator. If the pair in question has a '1' modifier, you can report both codes under certain circumstances and with enough supporting documentation. You will need to append one of the CCI associated modifiers to the column 2 code. The modifier unbundles the edit and allows payment for both services.
CCI 16.3 includes more than 19,000 new edit pairs.