January 11, 2018

The ACR Gets Correction for Erroneous X-Ray Code Edit

In response to actions by the American College of Radiology (ACR), Correct Coding Solutions (CCS) will seek approval from the Centers for Medicare & Medicaid Services (CMS) to correct an erroneous edit in the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) code edit for column 1 CPT code 71045 (Radiologic examination, chest; single view) with column 2 CPT code 74018 (Radiologic examination, abdomen; 1 view).

The ACR identified and informed CCS about the error on Jan. 4 after the code edit’s Jan. 1, 2018, implementation date.

CCS investigated the code pair edit 71045/74018 with a modifier indicator of “1” and determined that the edit was erroneously added to the NCCI. As the next step, CCS will apply with the CMS NCCI PTP workgroup to delete the edit in the April 1, 2018 quarterly version update retroactive to the edit’s Jan. 1 implementation date.

In the interim, CCS recommends providers do one of the following:

  • Hold claims for the denied code 74018 for dates of service Jan. 1, 2018, through March 31, 2018, performed on the same date of service by the same rendering provider as CPT code 71045
  • Appeal the denials of CPT code 74018 after the April 1, 2018, NCCI PTP version is installed, when the edit will appear deleted and inactive
  • Append a modifier 59 for different anatomic sites on claims with dates of service Jan. 1, 2018, through March 31, 2018, until the NCCI PTP edit appears as deleted on April 1, 2018

For more information, please contact the ACR’s Maria Tran at mtran@acr.org.