NCCI PTP edits updated, version 25.1 effective April 1, 2019

Mar 08, 2019
The Bottom Line

CMS announced a quarterly update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits, version 25.1, effective April 1, 2019.

CMS reports the following:

The Centers for Medicare & Medicaid Services (CMS) developed the NCCI to promote national correct coding methods and to control improper coding that leads to inappropriate payment in Part B claims. Version 25.1 includes 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. 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 occurred for the two practitioner NCCI edit files and the two NCCI edit files used for the Outpatient Code Editor (OCE). You only have to search the Column One/Column Two Correct Coding edit file for active or previously deleted edits. CMS no longer publishes a Mutually Exclusive edit file 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. The edits previously available in the Mutually Exclusive edit file are NOT deleted but are moved to the Column One/Column Two Correct Coding edit file.

Refer to the CMS NCCI webpage for additional information at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html. These coding policies 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.

Read the full MLN Matters article here.

 

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