January 22, 2016

CMS to Revise New HipPelvis NCCI Edits

In response to an appeal from the American College of Radiology (ACR), the Centers for Medicare & Medicaid Services (CMS) will revise hip-pelvis code pair edits implemented Jan. 1, 2016. The edits bundle column one CPT codes 73501-73503, 73521-73523, and 73552 with column two CPT codes 72170, 72190, 73501-73503, 73521-73523, and 73551.

The April 1, 2016, version of the National Correct Coding Initiative (NCCI) edits will allow the use of NCCI-associated modifiers to bypass the edits if the two procedures described by the code pair edits are performed at separate patient encounters on the same date of service.

These edits will be retroactive to Jan. 1, 2016, to allow the use associated modifiers. Radiology practices may want to hold these claims until April 1 when it is appropriate to report these code pairs on the same day by the same physician.