Change is the only constant in the healthcare world. Rapid advancements in technology, evolving treatment protocols, and shifting regulations necessitate continuous adaptation. Healthcare professionals must embrace change to provide the best patient care and stay at the forefront of the industry’s ever-evolving developments. Let’s have a look at the recent NCCI changes for the last quarter of 2023.
The National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits are in place to prevent incorrect payments for services that should not be billed together. Each edit consists of two codes: one in Column One and another in Column Two, both identified by HCPCS/CPT codes. When a healthcare provider submits both codes from an edit pair for the same patient on the same day, Medicare will only reimburse for the Column One code. The Column Two code will only be paid if a clinically appropriate NCCI PTP-associated modifier is also included.
For the fourth quarter of 2023, there are only three minor NCCI changes in code files, effective from October 1. These changes apply to code edits for both practitioners and hospitals. If your healthcare practitioners offer the services affected by these changes, it’s important to be aware of them, as they can have a significant impact on billing and reimbursement.
In the Practitioner PTP Edit files, you’ll find the following code pairs have revised edits:
Column 1 Column 2
31241 30802
49614 49622
49615 49622
In the Hospital PTP Edit files, you’ll find the following code pairs have revised edits:
Column 1 Column 2
31241 30802
49614 49622
49615 49622
The following is a list of NCCI changes that have occurred.
For the following code pair, the rationale is “Misuse of column two code with column one code.”
31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery
30802 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)
The Change: An edit can now be overridden by a modifier if it is deemed appropriate.
For the following code pairs,
49614 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, Spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or another prosthesis when performed, a total length of the defect(s); less than 3 cm, incarcerated or strangulated.
49615 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, Spigelian), any approach (ie, open, laparoscopic, robotic), recurrent.; 3 cm to 10 cm, reducible
49622 Repair of parastomal hernia, any approach (ie, open, laparoscopic, robotic), initial or recurrent, including implantation of mesh or another prosthesis, when performed; incarcerated or strangulated.
The reason for the NCCI changes is shifting from “mutually exclusive procedures” to “Misuse of column two code with column one code.”
MEDICODIO to the Rescue
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For more information on NCCI changes: Click Here!
