dwaldman
True Blue
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
Chapter 1 NCCI policy Manual 2017
MUE and NCCI PTP edits are based on services provided by the same physician to the same beneficiary on the same date of service. Physicians should not inconvenience beneficiaries nor increase risks to beneficiaries by performing services on different dates of service to avoid MUE or NCCI PTP edits.
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For example, a physician should not report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement...) when performed in the same anatomic region on the same date of service.
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Chapter 2 NCCI Policy Manual 2017
In certain circumstances critical care services are provided by the anesthesiologist. CRNAs may be paid for evaluation and management services in the critical care area if state law and/or regulation permits them to provide such services.
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Chapter 8 NCCI Policy Manual 2017
On January 1, 2017, CPT codes 62310-62319 were replaced by CPT codes 62320-62327. CPT codes 62321, 62323, 62325, and 62327 describe these injections with fluoroscopic or CT guidance, and CPT codes 62320, 62322, 62324, and 62326 describe these injections without imaging guidance.
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(2) If a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, only one UOS of CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) may be reported regardless of the number of injections needed to block this nerve and its branches.
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Chapter 9 NCCI Policy Manual 2017
3. When a comparative imaging study is performed to assess potential complications or completeness of a procedure(e.g., post-reduction, post-intubation, post-catheter placement, etc.), the professional component of the CPT code for the post-procedure imaging study is not separately payable and should not be reported. The technical component of the CPT code for the postprocedure imaging study may be reported
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17. CPT codes 72081-72084 describe radiologic examination of the entire spine, the codes differing based on the number of views. The other codes in the CPT code range 72020-72120 describe radiologic examination of specific regions of the spine differing based on the region of the spine and the number of views. If a physician performs a procedure described by CPT codes 72081-72084 and at the same patient encounter performs a procedure described by one or more other codes in the CPT code range 72020-72120, the physician should sum the total number of views and report the appropriate code in the CPT code range 72081-72084. The physician should not report a code from the CPT code range 72081-72084 plus another code in the CPT code range 72020-72120 for services performed at the same patient encounter
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18. Since the foot includes the toes and calcaneous bone, CPT code 73630 (radiologic examination, foot; complete, minimum of 3 views) includes radiologic examination of the toes and calcaneous. A physician should not report CPT code 73650 (radiologic examination; calcaneus, minimum of 2 views) or 73660 (radiologic examination; toe(s), minimum of 2 views) with CPT code 73630 for the same foot on the same date of service.
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9. Evaluation of an anatomic region and guidance for a needle placement procedure in that anatomic region by the same radiologic modality at the same or different patient encounter(s) on the same date of service are not separately reportable. For example, a physician should not report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement...) when performed in the same anatomic region on the same date of service. Physicians should not avoid these edits by requiring patients to have the procedures performed on different dates of service if historically the evaluation of the anatomic region and guidance for needle biopsy procedures were performed on the same date of service
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Chapter 10 NCCI policy manual 2017
CMS policy prohibits separate payment for duplicate testing or testing for the same analyte by more than one methodology. (See definition of analyte in Section M (General Policy Statements), subsection #2.)
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An analyte as used in this Manual refers to the entity measured by a quantitative or qualitative laboratory test or assay. Examples of analytes include, but are not limited to, the results of drug tests, urinalysis tests, molecular pathology tests, genomic sequence and molecular multianalyte tests, multianalyte assays with algorithmic analyses, chemistry tests, hematology and coagulation tests, immunology tests, tissue typing, transfusion medicine tests, microbiology tests, anatomic pathology (including surgical pathology and cytopathology) tests, cytogenetic tests, reproductive medicine tests, and other procedures/tests/assays listed in the Pathology and Laboratory section of the CPT Manual as well as clinical laboratory tests or assays assigned HCPCS level II codes
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For Calendar Year 2016, urine drug presumptive testing should have been reported with HCPCS codes G0477-G0479. These codes differed based on the level of complexity of the testing methodology. Only one code from this code range should have been reported per date of service. These codes were deleted January 1, 2017.
Beginning January 1, 2017, urine drug presumptive testing may be reported with CPT codes 80305-80307. These codes differ based on the level of complexity of the testing methodology. Only one code from this code range may be reported per date of service.
Beginning January 1, 2016, urine drug definitive testing may be reported with HCPCS codes G0480-G0483. These codes differ based on the number of drug classes including metabolites tested. Only one code from this code range may be reported per date of service.
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18. For calendar year 2016, urine drug presumptive testing should have been reported with HCPCS codes G0477-G0479. These codes were reported “per date of service” and should not have been reported with more than one UOS per day. These codes were deleted January 1, 2017.
Beginning January 1, 2017, urine drug presumptive testing may be reported with HCPCS codes 80305-80307. These codes are reported “per date of service” and should not be reported with more than one UOS per day.
Beginning January 1, 2016, urine drug definitive testing may be reported with HCPCS codes G0480-G0483. These codes are reported “per day” and should not be reported with more than one UOS per day.
Chapter 1 NCCI policy Manual 2017
MUE and NCCI PTP edits are based on services provided by the same physician to the same beneficiary on the same date of service. Physicians should not inconvenience beneficiaries nor increase risks to beneficiaries by performing services on different dates of service to avoid MUE or NCCI PTP edits.
_____________________________________________________________________________________________________________________________
For example, a physician should not report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement...) when performed in the same anatomic region on the same date of service.
_________________________________________________________________________________________________________________________________
Chapter 2 NCCI Policy Manual 2017
In certain circumstances critical care services are provided by the anesthesiologist. CRNAs may be paid for evaluation and management services in the critical care area if state law and/or regulation permits them to provide such services.
__________________________________________________________________________________________________________________________________
Chapter 8 NCCI Policy Manual 2017
On January 1, 2017, CPT codes 62310-62319 were replaced by CPT codes 62320-62327. CPT codes 62321, 62323, 62325, and 62327 describe these injections with fluoroscopic or CT guidance, and CPT codes 62320, 62322, 62324, and 62326 describe these injections without imaging guidance.
______________________________________________________________________________________________________________________
(2) If a physician injects the superior medial and lateral branches and inferior medial branches of the left genicular nerve, only one UOS of CPT code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) may be reported regardless of the number of injections needed to block this nerve and its branches.
________________________________________________________________________________________________________________________
Chapter 9 NCCI Policy Manual 2017
3. When a comparative imaging study is performed to assess potential complications or completeness of a procedure(e.g., post-reduction, post-intubation, post-catheter placement, etc.), the professional component of the CPT code for the post-procedure imaging study is not separately payable and should not be reported. The technical component of the CPT code for the postprocedure imaging study may be reported
__________________________________________________________________________________________________________________________________'
17. CPT codes 72081-72084 describe radiologic examination of the entire spine, the codes differing based on the number of views. The other codes in the CPT code range 72020-72120 describe radiologic examination of specific regions of the spine differing based on the region of the spine and the number of views. If a physician performs a procedure described by CPT codes 72081-72084 and at the same patient encounter performs a procedure described by one or more other codes in the CPT code range 72020-72120, the physician should sum the total number of views and report the appropriate code in the CPT code range 72081-72084. The physician should not report a code from the CPT code range 72081-72084 plus another code in the CPT code range 72020-72120 for services performed at the same patient encounter
______________________________________________________________________________________________________________________________
18. Since the foot includes the toes and calcaneous bone, CPT code 73630 (radiologic examination, foot; complete, minimum of 3 views) includes radiologic examination of the toes and calcaneous. A physician should not report CPT code 73650 (radiologic examination; calcaneus, minimum of 2 views) or 73660 (radiologic examination; toe(s), minimum of 2 views) with CPT code 73630 for the same foot on the same date of service.
_______________________________________________________________________________________________________________
9. Evaluation of an anatomic region and guidance for a needle placement procedure in that anatomic region by the same radiologic modality at the same or different patient encounter(s) on the same date of service are not separately reportable. For example, a physician should not report a diagnostic ultrasound CPT code and CPT code 76942 (ultrasonic guidance for needle placement...) when performed in the same anatomic region on the same date of service. Physicians should not avoid these edits by requiring patients to have the procedures performed on different dates of service if historically the evaluation of the anatomic region and guidance for needle biopsy procedures were performed on the same date of service
____________________________________________________________________________________________________________________________
Chapter 10 NCCI policy manual 2017
CMS policy prohibits separate payment for duplicate testing or testing for the same analyte by more than one methodology. (See definition of analyte in Section M (General Policy Statements), subsection #2.)
______________________________________________________________________________________________________
An analyte as used in this Manual refers to the entity measured by a quantitative or qualitative laboratory test or assay. Examples of analytes include, but are not limited to, the results of drug tests, urinalysis tests, molecular pathology tests, genomic sequence and molecular multianalyte tests, multianalyte assays with algorithmic analyses, chemistry tests, hematology and coagulation tests, immunology tests, tissue typing, transfusion medicine tests, microbiology tests, anatomic pathology (including surgical pathology and cytopathology) tests, cytogenetic tests, reproductive medicine tests, and other procedures/tests/assays listed in the Pathology and Laboratory section of the CPT Manual as well as clinical laboratory tests or assays assigned HCPCS level II codes
___________________________________________________________________________________________________________________________
For Calendar Year 2016, urine drug presumptive testing should have been reported with HCPCS codes G0477-G0479. These codes differed based on the level of complexity of the testing methodology. Only one code from this code range should have been reported per date of service. These codes were deleted January 1, 2017.
Beginning January 1, 2017, urine drug presumptive testing may be reported with CPT codes 80305-80307. These codes differ based on the level of complexity of the testing methodology. Only one code from this code range may be reported per date of service.
Beginning January 1, 2016, urine drug definitive testing may be reported with HCPCS codes G0480-G0483. These codes differ based on the number of drug classes including metabolites tested. Only one code from this code range may be reported per date of service.
__________________________________________________________________________________________
18. For calendar year 2016, urine drug presumptive testing should have been reported with HCPCS codes G0477-G0479. These codes were reported “per date of service” and should not have been reported with more than one UOS per day. These codes were deleted January 1, 2017.
Beginning January 1, 2017, urine drug presumptive testing may be reported with HCPCS codes 80305-80307. These codes are reported “per date of service” and should not be reported with more than one UOS per day.
Beginning January 1, 2016, urine drug definitive testing may be reported with HCPCS codes G0480-G0483. These codes are reported “per day” and should not be reported with more than one UOS per day.
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