It is that time of year where updates are abound. The National Correct Coding Initiative (NCCI) manuals are updated every year reflective of coding changes and Centers for Medicare and Medicaid Services (CMS) policy changes. The following are highlights of the 2022 changes to the NCCI manuals.
Every chapter had the term “supplier” added to now read “providers/suppliers.” The respective NCCI Policy Manuals can be found here.
CHAPTER 1 – General Coding Policies
There are updates to general coding requirements related to biopsies. The 2022 revision states that a separate biopsy can only be reported when the pathologic examination results in a decision to immediately proceed with a more extensive procedure on the same lesion; or when performed on a separate lesion.
Biopsies should not be reported when it is to assess resection of margins or verify resectability or when performed and submitted for pathologic evaluation completed after performing a more extensive procedure.
Modifier 59 cannot be used with 77427 Radiation treatment management, 5 treatment. Restriction of modifier 59 with this code is not found within the CPT® manual. This highlights the importance of also looking to the NCCI manual for further coding guidance.
CHAPTER 2 – Anesthesia Services (00000-01999)
The NCCI manual has clarified, as a general rule, CMS dot not allow separate payment for anesthesia services performed by the physician who also furnishes the medical or surgical service. Payment for the anesthesia services is included in the payment for the medical or surgical procedure. Likewise, under OPPS, the payment for anesthesia services is included in the payment for the medical surgical procedure.
CHAPTER 3 – Integumentary System (10000-19999)
CMS clarified when it is medically necessary to remove multiple lesions separately, it may be appropriate for the procedure to be reported by multiple HCPCS/CPT codes using the correct anatomic modifier 59 or XS to indicate the different lesion site.
CHAPTER 4 – Musculoskeletal System (20000-29999)
Casting/splinting/strapping has undergone language expansion to indicate if a service from the Musculoskeletal System section of CPT (20100-28899 and 29800-29999) is also performed for the same anatomic area there is no separate reporting of casting/splinting/strapping.
When reporting manual therapy techniques (e.g., CPT 97140) in the anatomic region where a multi-layer compression system (e.g., CPT codes 29581-29584) is applied, it may be necessary to indicate the manual therapy techniques are distinct from the multi-layer compression system application, modifier -59 or -x{EPSU} may be appended to either column code.
CHAPTER 5 – Respiratory, Cardiovascular, Hemic and Lymphatic Systems (30000-39999)
Repeat angiograms can be reported with modifier 59 or XU. Modifier XU has been added as an additional reportable modifier.
Clarification has been provided regarding dialysis circuit (36901-36906). Codes 36901-36906 which represent dialysis circuit should only have one code reported from this code which. CPT codes 36907 and 36908 are add-on codes reported with 36901-36906 as appropriate. The codes can only be reported once per session regardless of the number of lesions treated. CPT 36909 is an add-on code reported with 36901-36906 as appropriate to describe endovascular embolization or occlusion and may be reported only once per session regardless of the number of branches or embolized or occluded.
Changes such as the above will have direct implications on medically unlikely edits (MUEs). MUE values are set to a level in which exceeding such MUE value would be uncommon. Depending on the type of adjudication indicator associated with the MUE, the MUE may be appealed or be allowed to report the code on another claim line with an appropriate modifier.
CHAPTER 6 – Digestive System (40000-49999)
There were no material changes to this chapter.
CHAPTER 7 – Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems (50000-59999)
There were no material changes to this chapter.
CHAPTER 8 – Endocrine, Nervous, Eye and Ocular Adnexa, and Auditory Systems (60000-69999)
There were no material changes to this chapter.
CHAPTER 9 – Radiology Services (70000-79999)
Modifier 59 cannot be used with 77427 Radiation treatment management, 5 treatment. Restriction of modifier 59 with this code is not found within the CPT® manual.
CHAPTER 10 – Pathology / Laboratory Services (80000-89999)
CMS has clarified the term “reflex test.” A reflex test is a laboratory test which requires further follow-up testing which is implicit in the physician’s order. For example, a urine culture is positive, the lab proceeds to identify the organism which is separately reportable. The initial result has limited value without a separate follow-up (reflect test).
Other lab test results may or may not require additional testing in order to have clinical value. This type of additional testing must be distinguished from reflex testing. The additional testing is not implicit in the initial physician order. For example, a test for monoclonal protein band. The physician’s initial order does not implicitly include any additional testing. If the patient has a known monoclonal gammopathy, the additional testing would not be appropriate unless ordered by the treating physician.
CPT codes 80503-80506 are new codes for clinical pathology consultation services. Reporting of these services may be based on either the total time for pathology clinical consultation services performed on the date of consultation or level of medical decision making. There must be a written order for the clinical pathology consultation from the treating physician. A standard order is not acceptable.
CHAPTER 11 – Evaluation and Management Services (90000-99999)
No material changes. Most changes were addition of words consistent with the code descriptions but no rule changes.
CHAPTER 12 – Supplemental Services HCPCS Level II Codes (A0000-V9999)
There were no material changes to this chapter.
CHAPTER 13 – Category III Codes (0001T-0999T)
There were no material changes to this chapter.
