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Frequently Asked Questions

FAQ: Code Edits I’ve Applied for Years Seem to Have Disappeared in Q2 2020. Why?

 

 

Medicare posted quarterly replacement files for National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) coding edits featuring many deletions in the second quarter (Q2) of 2020. As an example, Medicare deleted roughly 291,900 edit pairs for NCCI PTP physician/practitioner edits.

 

Medicare’s NCCI Edits page explains that the deletions are related to Medicare’s expansion of telehealth services in response to the COVID-19 public health emergency.

 

Despite the deletions, you still need to be cautious when reporting these code pairs. “Payments based on the expansion of telehealth services are for dates of services starting March 6, 2020,” Medicare’s NCCI Edits page states. And any time you’re considering reporting two codes together, you need to evaluate whether you’re coding properly according to CPT® and HCPCS Level II coding rules, NCCI policies, and payer policies (such as global surgical packages). This approach to correct coding holds true regardless of whether there’s an edit for those particular codes.

 

Tip: To check whether a code pair has a valid edit, you can download the official NCCI edit files from Medicare’s PTP Coding Edits page. If you find an edit listed for your code pair, be sure to check column E to see if a deletion date is posted for the edit. The edit is not valid after that deletion date.