January 06, 2017

CMS to Correct Errors to NCCI Sedation Code Edits

The American College of Radiology (ACR) has notified members that the Centers for Medicare & Medicaid Services (CMS) intends to correct errors to the 2017 National Correct Coding Initiative (NCCI) procedure-to-procedure edits for moderate sedation.

The College was informed on Dec. 23 in an electronic letter from Niles R. Rosen, MD, medical director of NCCI, that CPT® codes 99151-99153 were incorrectly bundled into 17 global surgical procedures and 16 category III codes. These edits do not allow bypass with NCCI-associated modifiers (modifier indicator of “0”).

Errors applicable to moderate sedation will be corrected in the April 1, 2017, versions of procedure-to-procedure edits. CMS has yet to determine whether a work-around can be implemented for Medicare or any of the state Medicaid programs. An attachment to the letter provided a detailed list of incorrect edits to be deleted retroactively to Jan. 1, 2017.

Rosen suggested that practitioners may want to consider delaying claims submissions for CPT codes 99151-99153 when performed with one of the listed surgical or Category III codes until the new versions of NCCI procedure-to-procedure edits are implemented. If claims are submitted for these code pairs for the same date of service and the claims are denied, the denial may be appealed on or after April 1.