July 11, 2018

ACR Gains Reversal on Bone Biopsy NCCI Edits

An appeal by the American College of Radiology (ACR) has led the Centers for Medicare & Medicaid Services (CMS) to revise the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits for bone biopsy procedures.

The PTP edits apply to CPT codes 20220 (Biopsy, bone, trocar, or needle; superficial [eg, ilium, sternum, spinous process, ribs]) and 20225 (Biopsy, bone, trocar, or needle; deep [eg, vertebral body, femur]) reported in conjunction with CPT code 38222 (Diagnostic bone marrow; biopsy[ies] and aspiration[s]).

These edits were first implemented on January 1, 2018, to allow the use of NCCI-associated modifiers to bypass edits if the two procedures were performed at separate anatomic sites. The edits were modified on July 1, 2018, to no longer allow use of NCCI- associated modifiers. The ACR objected to this modification in writing to NCCI, which resulted in CMS reversing this decision.

For the October 1, 2018 version of NCCI, the edits will again allow use of NCCI-associated modifiers as described above. The modification of the modifier indicators will be retroactive to July 1, 2018.