April 22, 2016

CMS to Modify PTP NCCI Indicator for Scoliosis Evaluation

The Centers for Medicare & Medicaid Services (CMS) will modify procedure-to-procedure (PTP) edits for CPT code pairs 72082/72081; 72083/72081, 72082; and 72084/72081, 72082, 72083 in the July 1, 2016 version of National Correct Coding Initiative (NCCI) to allow the use of NCCI-associated modifiers when the two procedures described are performed at separate patient encounters on the same date of service. The modification of the modifier indicators will be retroactive to January 1, 2016.

Column 1 Code Column 2 Code Current Modifier Indicator (Incorrect)
January 1, 2016
Corrected Modifier Indicator
The American College of Radiology (ACR), the American Pediatric Surgical Association (APSA), the International Society for the Advancement of Spine Surgery (ISASS) and the Spine Intervention Society (SIS) appealed the modifier status of the PTP edits for CPT code pairs 72082/72081; 72083/72081, 72082; and 72084/72081, 72082, 72083. These spine edits implemented on January 1, 2016 by CMS have edits against themselves with a status modifier of “0.”

The ACR, APSA, ISASS and SIS strongly disagreed with the assignment of a modifier indicator of “0”as these edits do not allow for billing for two separate scoliosis series performed on the same day.

As noted in the multispecialty appeal letter addressed to Niles Rosen, NCCI medical director, these edits present a real problem at facilities that care for scoliosis patients, especially medical services such as pediatric hospitals, that perform scoliosis surgery. It is not uncommon to get a scoliosis study in the morning, decide later in the day that bilateral side-to-side bending views are needed for pre-operative measurements for hardware planning, do an intraoperative entire spine examination to evaluate effectiveness of hardware placement and then perform a post-operative entire spine exam to see results of fixation. Because such instances occur regularly, the ACR, APSA, ISASS and SIS strongly disagree with a status modifier of “0” and requested that the status modifier be changed to a “1” to allow the use of a modifier to bypass the edits.