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.

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