Medicare Compliance & Reimbursement - 2019 Issue 3
Part B Coding Coach: Review These New PTP Edit Pairs
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Article Overview
This article summarizes a subset of 2019 Correct Coding Initiative procedure-to-procedure edit changes for Part B coding readers. It focuses on how new and revised edit pairs affect biopsies, chronic care management, psychological and neuropsychological testing, adaptive behavior services, and certain evaluation and management categories. The discussion is intended for coders, billers, compliance staff, and other Medicare-focused reimbursement professionals who need a broad overview of where the new edit activity is concentrated and why it matters for claim review.
Why This Topic Matters
CCI edit updates can affect whether paired services are separately reportable and whether claims are more likely to deny. Understanding which service families were newly paired helps coding teams review documentation, billing workflows, and compliance processes for 2019.
Article Sections
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New Biopsy Codes Bring New Edits
This section reviews the concentration of new edit pairs involving skin biopsy services and related integumentary procedures. It also notes the way these edits interact with other procedure families and modifier indicators.
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Especially With E/M Services
This section discusses how the biopsy-related edits intersect with selected evaluation and management services. It highlights differences among new patient visits, established patient visits, consultations, and telehealth-style consultation services.
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Take Care with New Chronic Care Management Code …
This section covers the new chronic care management code and the groups of services that were assigned new edit relationships with it. It addresses the broader care management and non-face-to-face service categories affected by the update.
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... and Don’t Let the New Psych Codes Psych You Out
This section summarizes the new psychological and neuropsychological testing evaluation codes and their edit relationships with adaptive behavior assessment and treatment services. It provides a high-level view of the affected service families.
What You Will Learn
- Which broad service categories were most affected by the 2019 CCI PTP update
- How the article organizes the update by biopsy, E/M, chronic care management, and psych testing service groups
- Which types of Medicare coding relationships the article highlights for review
- Why modifier indicators are part of the discussion for certain affected service pairings
Who Should Read This
- Medical coders
- Billing staff
- Compliance analysts
- Physician practice administrators
- Medicare reimbursement professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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