by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Jun 10th, 2020
There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020 actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE). The updated files included:
- 291,902 Deleted Procedure to Procedure (PTP) edits
- 197 Deleted Medically Unlikely edits (MUE)
This was no small change. The deleted PTP pairs include anesthesia services and procedures as well as E/M visits. We have included a spreadsheet for your reference which can be reviewed here: CMS April 01, 2020 Revisions.
Edits Removed from CCI editor with E/M and Modifier 25
One significant change in the 291,902 Procedure to Procedure (PTP) edits was the removal of the edits with E/M codes. Prior to this change, we would see an ERROR or a WARNING looking for a CCI-associated modifier such as a 25, but those edits have been removed.
Change your viewing date to see the edits prior to the new changes
(Some edits are effective Jan 01, 2020, and some are effective April 01, 2020)
Removing the edits on the E/M codes will now allow the use of the new or existing telemedicine service codes. Telemedicine codes are identified with a STAR ICON on the code information page, indicating they can be used as a telemedicine service as well as face-to-face.
Prior to April 01, 2020:
- This edit CANNOT be overridden via CCI-associated modifiers.
|00100- OK- NCCI Edit Results: No NCCI Edits for this code.|
After April 01, 2020:
|99201 OK- NCCI Edit Results: No NCCI Edits for this code.|
|00100 OK- NCCI Edit Results: No NCCI Edits for this code.|
Keep an eye on the MUEs, as the frequency limits have been eliminated for the use of telehealth and other communication-based services; this involves 199 codes. We are not sure if this is temporary or a permanent change.
It is important to note that if there is not a CCI edit or a warning, you are still required to follow standard coding guidelines and rules. If there is an NCCI policy or rule, refer to the current NCCI Policy Manual for Medicare Services. The policy manual addresses all of the CCI policies and can be found on the NCCI Page in Find-A-Code at the top of the page, which makes it easily accessible.
See the NCCI Policy Manual: Chapter I Section D, Evaluation and Management (E&M) Services for the use of Modifier 25.
For additional information on using Modifier 25 with E&M codes, refer to this article: "Where is the CCI Edit with Modifier 25 on E/M?"
Important NOTE: The NCCI edit manual is updated yearly in October, however, there may be quarterly changes that are not showing on the current manual. For updated quarterly Replacement, Additions, Deletions, and revisions visit CMS Quarterly PTP and MUE Version Update Changes.
About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.