CMS Issues Quarterly Update to the NCCI PTP Edits

January 2020 ~

As a guide for physicians, providers, and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries, CMS has released an update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits. The agency hopes the update will promote national correct coding methodologies and to control improper coding that can lead to inappropriate payment in Part B claims.

According to the announcement, the latest package of NCCI Procedure-to-Procedure (PTP) edits, Version 26.1, will include all previous versions and updates from January 1, 1996 to the present.

In the past, NCCI was organized in two tables: Column 1/Column 2 Correct Coding Edits and Mutually Exclusive Code (MEC) Edits. In an effort to simplify the use of NCCI edit files (two tables), on April 1, 2012, CMS consolidated these two edit files into the Column One/Column Two Correct Coding edit file. Separate consolidations have occurred for the two practitioner NCCI edit files and the two NCCI edit files used for the Outpatient Code Editor (OCE). It will only be necessary to search the Column One/Column Two Correct Coding edit file for active or previously deleted edits.

NOTE: CMS no longer publishes a Mutually Exclusive edit file on its website for either practitioner or outpatient hospital services, since all active and deleted edits will appear in the single Column One/Column Two Correct Coding edit file on each website. The edits previously contained in the Mutually Exclusive edit file are NOT being deleted but are being moved to the Column One/Column Two Correct Coding edit file.

The latest package of NCCI Procedure-to-Procedure (PTP) edits, Version 26.1 effective April 1, 2020, will be available via the CMS Virtual Data Center (VDC). A test file will be available on or about January 31, 2020, and a final file will be available on or about February 14, 2020.

The coding policies developed are based on coding conventions defined in the American Medical Association’s Current Procedural Terminology manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practice, and review of current coding practice.

For additional information, view the official instruction, CR11628, issued to MACs regarding the change or refer to the CMS NCCI webpage.

Source(s): MLN Matters Number: MM11628;