General Question for the Week of July 9, 2018

Question:

I know that providers are supposed to check the PTP edits before submitting Medicare claims, but what about the mutually exclusive edits?

Answer:

Transmittal R4080CP (issued June 29, 2018) announces the next update of the national correct coding initiative (NCCI) will take effect on October 1. In that transmittal, the Centers for Medicare & Medicaid Services (CMS) state that it is only necessary to search the column one/column two correct coding edit file for active or previously deleted edits. CMS no longer publishes a mutually exclusive edit file on its website for either practitioner or outpatient hospital services, since all active and deleted edits will appear in the single column one/column two correct coding edit file. The edits previously contained in the Mutually Exclusive edit file are NOT being deleted, just moved.

This information can be found at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4080CP.pdf.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

General Question for the Week of July 9, 2018

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