• Minor NCCI edits Take Effect April 1

    The latest National Correct Coding Initiative edits, version 22.1, released by the Centers for Medicare and Medicaid Services determined that several codes bundled back in 2009 should now have their add-on codes bundled as well. These changes have little impact on ophthalmic practices. The edits took effect April 1, 2016.

    In 2009, CCI bundled the following CPT codes with E/M exam codes, including many ophthalmic procedures. These existing edits include an indicator of 1, meaning you can unbundle these codes when the service provided satisfies the definition of modifier -59 or the new –X modifiers. Typically –X modifiers apply when the procedures are performed in separate eyes.

    • 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour, and
    • 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour.

    As of April 1, 2016 their add-on codes are now bundled with those same ophthalmic services, and include the indicator 1.

    • 96361 Each additional hour
    • 96366 Each additional hour
    • 96367 Additional sequential infusion of a new drug/substance, up to 1 hour
    • 96368 Concurrent infusion

    For a complete listing of version 22.1 CCI edits, visit the CMS NCCI page