2019 NCCI update impact on medical billing and coding

NCCI – National Correct Coding Initiative promotes the correct coding methodologies. Furthermore, it controls inappropriate coding leading to wrong payments in Part B claims. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services. The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits. Further, read more about 2019 NCCI update impact on medical billing and coding.

CMS recently happens to release the 2019 NCCI policy manual for Medicare services. The updates are all about new payment policies, coding methodologies as well as changes that will impact billing and coding for spinal surgeries and laboratory services.

The new changes made by CMS added new guidance to chapter 4 for spinal procedures that clarify the reporting of CPT codes 22600-22634 for spinal arthrodesis.

The New NCCI Update

CMS also revised this section to include a procedure-to-procedure (PTP) edit with column one CPT code 22630 which includes arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace and other than for decompression, single interspace; lumbar and column two CPT code 63056 includes arthrodesis, transpedicular approach with decompression of spinal cord, and/or nerve root, single segment; lumbar.

As per the updated manual, the two procedures cannot be reported together at the same spinal level for the same patient encounter.

A Tier 1 or Tier 2 molecular pathology procedure CPT code should not be reported with a genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis, or proprietary laboratory analysis. CPT code descriptors for Tier 1 and Tier 2 molecular pathology codes include testing for the analyte.

The update includes guidance for reporting laboratory procedures to evaluate multiple genes utilizing the next-generation sequencing procedure:

  • If only one procedure is performed, only one unit of service should be reported for the genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis, or proprietary laboratory analysis CPT code.
  • If no CPT code accurately describes the procedure, the lab must report CPT code 81479 i.e. unlisted molecular pathology procedures with one unit of service.

MBC – One-stop shop for a coding & billing skills upgrade

Navigating the medical coding and compliance world gets easier with expert guidance. MBC is one of the known knowledgeable healthcare industry’s most expert veterans to outsource your medical billing and coding requirements.

Here’s just a sampling of the 2019 medical billing and coding services available from MBC:

  • Speed on 2019 CPT, ICD-10-CM, and Medicare updates
  • Navigate CPT definition changes
  • Prepare for the 2019 NCCI bundling and unbundling for various procedures
  • Prevent modifier misuse e.g. modifier 59 from ruining claims and causing denials
  • Follow CPT guidelines for using time as a key factor to determine E&M service level
  • HIPAA & Patient Communication: How to handle text, email, and access issues
  • Receive proper NPP reimbursement by avoiding compliance risks
  • Clear up confusion over ‘medical necessity’ documentation
  • Follow CMS guidelines for physician documentation and E&M codes
  • Learn what 2019 has in store: compliance, quality measures, value-based reporting, audit risk areas, and documentation guidelines
  • Gain tips to minimize denials and nip cash flow problems in the bud
  • Make 2019 maximum reimbursement kind of year