There are 2,115 additions to the third quarter Medicare National Correct Coding Initiative (NCCI or CCI) practitioner edits that became effective July 1, 2019. The good news is that the bulk of the new edits affect a comparatively small number of highly specialized HCPCS codes.
Around three-quarters of the additions, 1,604 to be exact, involve just five HCPCS therapeutic service procedures that CMS introduced at the beginning of 2019:
- C9751 (Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by microwave energy, including fluoroscopic guidance, when performed, with computed tomography acquisition(s) and 3-d rendering, computer-assisted, image-guided navigation, and endobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]) and all mediastinal and/or hilar lymph node stations or structures and therapeutic intervention(s))
- C9752 (Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum)
- C9753 (Destruction of intraosseous basivertebral nerve, each additional vertebral body, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum (list separately in addition to code for primary procedure))
- C9754 (Creation of arteriovenous fistula, percutaneous; direct, any site, including all imaging and radiologic supervision and interpretation, when performed and secondary procedures to redirect blood flow (e.g., transluminal balloon angioplasty, coil embolization, when performed))
- C9755 (Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed).
What the Codes and the Edit Pairs Mean
Code C9751 is an outpatient hospital code that describes the removal of lung lesions using microwaves, while both C9752 and C9753 are used in the treatment of chronic low back pain. And C9754 and C9755 are procedures designed to facilitate hemodialysis treatments.
Many of the edit pairs help to prevent you from reporting the column 2 code when it represents a service that is not distinct from the column 1 code, but you’ll still be able to report the codes separately when you meet the requirements, such as separate session or site. An example is performing a medically necessary and distinct 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) at a different session but on the same date as ablation represented by C9751. That’s why, when these C codes are the column 1 code for the edit pair, CCI gives most of the edits a modifier indicator of 1, meaning that you can unbundle the codes in the edit pair with an appropriate modifier.
Watch for These 0 Indicator Edits
There are a handful of key 0 modifier indicator pairs among the current additions to the CCI edits, however. If you use, or plan to use, any of the five codes, make sure you watch for the following because you won’t be able to unbundle the procedures with a modifier. That means payers who follow Medicare’s lead will not pay for the column 2 code if you report both procedures for the same beneficiary and same provider on the same date of service.
- You cannot bill C9751 with many of the endoscopy and bronchoscopy codes (31615-31653), with the exception of tracheobronchoscopy code 31615, bronchoscopy with biopsy code 31625, and bronchoscopy with tumor excision code 31640.
- You also cannot bill C9751 with any of the diagnostic or therapeutic substance injection codes (62320-62327) or any of the diagnostic or therapeutic nerve block introduction/injection codes (64400-64530).
- You will not be able to bill C9752 and C9753 with a number of the needle electromyography codes (95860-95870), with most of the nerve conduction tests (95907-95913), or with most evoked potential and reflex tests (95925-95940).
- In addition, Medicare will not allow you to bill C9752 or C9753 with any of the interprofessional consultation codes (99446-99452) or with the transitional care management codes (99495-99496).
- Like C9751, Medicare will also not permit C9754 and C9755 with any of the diagnostic or therapeutic substance injection codes (62320-62327) or any of the diagnostic or therapeutic nerve block introduction/injection codes (64400-64530).
- Also, like C9752 and C9753, you are not permitted to bill C9754 and C9755 with any of the interprofessional consultation codes (99446-99452) or with the transitional care management codes (99495-99496).
View the Full List of CCI Edits
To see if any of your most-used codes are affected by this latest round of edits, download the zip file Quarterly Additions, Deletions, and Modifier Indicator Changes to NCCI edits for Physicians/Practitioners (column 1/column 2 edits and mutually exclusive code edits) Effective July 1, 2019.
Learn about CCI edits and the large number that appeared in the first quarter here.