July 06, 2016

Fine Needle Aspiration NCCI Edits Reversed after Multi-Society Appeal

In response to an appeal by the American College of Radiology (ACR), the American Roentgen Ray Society and Radiological Society of North America, the 2016 National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits for CPT code 10022 (Fine needle aspiration; with imaging guidance) reported in conjunction with CPT code 10035 (Placement of soft tissue localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion) will be deleted in the October 2016 NCCI quarterly update.

In addition, the Centers for Medicare and Medicaid (CMS) will delete PTP edits for CPT code 10022 reported in conjunction with the placement of breast localization devices, CPT codes 19281, 19283, 19285 and 19287.

The radiology specialty societies argued there simply is no overlap of work between these codes. The ACR and Society of Interventional Radiology have already recommended in the 2016 Interventional Radiology Coding Update that imaging guidance (e.g., CPT codes 76942, 77012) should not be reported when 10022 is performed in conjunction with 10035-10036 or 19281-19288.

CMS will delete these edits in the next version of the NCCI quarterly updates scheduled for October 1, 2016. According to CMS, these edits will not be retroactive to January 1, 2016.