NCCI 11.3 Update
Over 500 National Correct Coding Initiative (NCCI) edits are proposed for implementation on October 1, 2005 in version 11.3 by the Centers for Medicare and Medicaid Services (CMS).
About 100 of the 500 proposed NCCI edits are related to radiology services. The majority of these edits bundle PET, PET/CT, and diagnostic CT code pair combinations. As a result of ACR efforts, CMS will allow for modifier use when a separate diagnostic CT is medically necessary when performed on the same day as a PET or PET/CT. However, for PET and PET/CT code pair combinations, no modifier is allowed and, therefore, cannot be billed on the same day and by the same physician. For examples of appropriate PET/CT, PET and diagnostic CT coding guidelines, please refer to the May-June 2005 ACR Radiology Coding Source™ feature article titled PET/CT Coding Questions Answered.
In addition to the above, code pair combinations are proposed to bundle the 2D and 3D reconstruction code (76375) with PET/CT and other nuclear medicine services within the 78XXX series. However, these edits will allow the use of a modifier if the 3D rendering service (76375) is performed separately for a CT, MRI, ultrasound, or other non-nuclear medicine tomographic procedure, when performed on the same day and by the same physician.
For further information regarding the 11.3 NCCI edits impacting radiology, please refer to the CMS and ACR correspondence at http://www.acr.org/s_acr/sec.asp?CID=3513&DID=21907.
Clarification on Version 11.2 Bone Density Edits
The May-June 2005 ACR Radiology Coding Source™ posted an NCCI Update article on edits that paired axial bone density studies and edits that paired peripheral bone density studies. As per the January 6, 2005 CMS letter, the ACR wants to clarify that these NCCI edits are based on the principle that a provider should not report more than one axial or more than one peripheral bone density study on the same date of service. Note that the July 2005 edits do not pair axial and peripheral bone density study codes with each other. Please reference the 1/6/05 CMS letter [link] for a listing of the respective code pair edit combinations implemented and the rationale for each.
A complete list of NCCI edits (effective July 1 – September 30, 2005) can be accessed at www.cms.hhs.gov/physicians/cciedits.
