March 18, 2020

CMS Deletes NCCI PTP Edit for Intercostal Nerve Injection

The Centers for Medicare and Medicaid Services (CMS) will delete the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edit for CPT code pair 64420, Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level, with 64421, Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, each additional level (List separately in addition to code for primary procedure).

The American College of Radiology® (ACR®), along with Society of Interventional Radiology, American Roentgen Ray Society, Association of University Radiologists and Radiological Society of North America appealed the NCCI PTP edit.

Code 64421 is an add-on code that cannot be billed by itself and should be reported with the primary code 64420 as noted in the CPT® 2020 codebook parenthetical. These procedures are typically performed during the same session by the same provider and for similar indications. In almost all situations, assigning a NCCI PTP edit between the primary and add-on code will prevent reporting of these codes together.

CMS will delete the PTP edit. The change will be implemented in the next quarterly NCCI edit update and will be retroactive to Jan. 1, 2020.

NCCI PTP updates are available for Medicare and Medicaid on the CMS website.

Questions and comments may be directed to Maria Tran, ACR director of economics and health policy.