February 28, 2016

ACR Appeals Inappropriate 2016 NCCI Edits

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The American College of Radiology (ACR) will appeal several National Correct Coding Initiative (NCCI) edits implemented by the Centers for Medicare & Medicaid Services (CMS) on Jan. 1, 2016. 

Inappropriate edits include the following:
  • Renal biopsy (50200) performed in conjunction with fluoroscopy, computed tomography, magnetic resonance imaging and ultrasound guidance (77002, 77012, 77021, 76942/76942)
  • Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (e.g., scoliosis evaluation) code pair combinations (72082-72084)
  • Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm (50080, 50081) with fluoroscopy (76000, 76001)
  • Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit (50688) in conjunction with placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed with imaging guidance (e.g., ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation (50693, 50694, 50695) 
In addition, the ACR will reappeal the NCCI edits covering ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation (76942) with ultrasound, soft tissues of head and neck (e.g., thyroid, parathyroid, parotid), real time with image documentation (76536). 

In conjunction with the American Society for Radiation Oncology, the College will again request the deletion of three-dimensional radiotherapy planning, including dose-volume histograms (77295) with basic radiation dosimetry calculation (77300). The ACR strongly disagrees with these code pair edits and will continue to recommend their deletion.

Questions and comments may be directed to Diane Hayek, ACR director of economics and health policy, at dhayek@acr.org or 1-800-227-5463 ext. 4922.