NATIONAL CORRECT CODING INITIATIVE’S (NCCI) GENERAL ...

1 NATIONAL CORRECT CODING INITIATIVE S (NCCI) GENERAL CORRESPONDENCE LANGUAGE AND SECTION SPECIFIC EXAMPLES (FOR NCCI PROCEDURE TO PROCEDURE (PTP) EDITS AND MEDICALLY UNLIKELY EDITS (MUE)) Revised: January 1, 2020 Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, prospective payment systems, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use.

2 The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. Page 2 of 53 Medicare - Revision 01/01/2020 Introduction .. 10 NATIONAL CORRECT CODING Initiative s .. 13 GENERAL Correspondence Language for NCCI PTP Edits and Medically Unlikely Edits (MUEs) .. 13 1. Standard preparation/monitoring services for anesthesia .. 13 2. HCPCS/CPT procedure code definition .. 13 3. CPT Manual or CMS manual CODING instruction .. 13 4. Mutually exclusive procedures.

3 13 5. Sequential procedure .. 14 6. CPT Separate procedure definition .. 14 7. More extensive procedure .. 14 8. Reserved for Future Use .. 14 9. Gender-specific procedures .. 15 10. standards of medical/surgical practice .. 15 11. Anesthesia service included in surgical procedure .. 15 12. Laboratory panel .. 15 13. Deleted/modified edits for NCCI .. 16 14. Misuse of Column Two code with Column One code .. 16 15. Medically Unlikely Edits (MUE) (UOS) .. 16 16. Deleted/modified edits for MUE .. 16 Section-specific Examples .. 18 Anesthesia Services .. 18 CPT Codes 00000-09999 .. 18 Correspondence Language Policy/Example Number - Standard preparation/monitoring services for anesthesia.

4 18 Correspondence Language Policy/Example Number - CPT Manual or CMS manual CODING 18 Correspondence Language Policy/Example Number More extensive procedure .. 18 Correspondence Language Policy/Example Number - Misuse of Column Two code with Column One code .. 18 Correspondence Language Policy/Example Number Medically Unlikely Edits (UOS) .. 18 Medically Unlikely Edits (UOS) do not apply to Anesthesia Services (CPT codes Page 3 of 53 Medicare - Revision 01/01/2020 00100-01995).. 19 Integumentary System .. 20 CPT Codes 10000-19999 .. 20 Correspondence Language Policy/Example Number HCPCS/CPT procedure code definition.

5 20 Correspondence Language Policy/Example Number - CPT Manual or CMS manual CODING 20 Correspondence Language Policy/Example Number - Mutually exclusive procedures .. 20 Correspondence Language Policy/Example Number - Sequential procedure .. 21 Correspondence Language Policy/Example Number CPT separate procedure definition .. 21 Correspondence Language Policy/Example Number - More extensive procedure .. 21 Correspondence Language Policy/Example Number - standards of medical/surgical practice .. 21 Correspondence Language Policy/Example Number - Anesthesia service included in surgical procedure.

6 22 Correspondence Language Policy/Example Number - Misuse of Column Two code with Column One code .. 22 Correspondence Language Policy/Example Number Medically Unlikely Edits (UOS) .. 22 Musculoskeletal System .. 23 CPT Codes 20000-29999 .. 23 Correspondence Language Policy/Example Number - HCPCS/CPT procedure code definition .. 23 Correspondence Language Policy/Example Number - CPT Manual or CMS manual CODING 23 Correspondence Language Policy/Example Number - Mutually exclusive procedures .. 23 Correspondence Language Policy/Example Number - Sequential procedure .. 23 Correspondence Language Policy/Example Number CPT separate procedure definition.

7 24 Correspondence Language Policy/Example Number - More extensive procedure .. 24 Correspondence Language Policy/Example Number - standards of medical/surgical practice .. 24 Page 4 of 53 Medicare - Revision 01/01/2020 Correspondence Language Policy/Example Number - Anesthesia service included in surgical procedure .. 24 Correspondence Language Policy/Example Number - Misuse of Column Two code with Column One code .. 25 Correspondence Language Policy/Example Number Medically Unlikely Edits (UOS) .. 25 Respiratory System, Cardiovascular System, Hemic and Lymphatic Systems, Mediastinum and Diaphragm.

8 26 CPT Codes 30000-39999 .. 26 Correspondence Language Policy/Example Number - HCPCS/CPT procedure code definition .. 26 Correspondence Language Policy/Example Number - CPT Manual or CMS manual CODING 26 Correspondence Language Policy/Example Number - Mutually exclusive procedures .. 26 Correspondence Language Policy/Example Number - Sequential procedure .. 26 Correspondence Language Policy/Example Number CPT separate procedure definition .. 27 Correspondence Language Policy/Example Number - More extensive procedure .. 27 Correspondence Language Policy/Example Number - standards of medical/surgical practice.

9 27 Correspondence Language Policy/Example Number - Anesthesia service included in surgical procedure .. 27 Correspondence Language Policy/Example Number - Misuse of Column Two code with Column One code .. 28 Correspondence Language Policy/Example Number Medically Unlikely Edits (UOS) .. 28 Digestive System .. 29 CPT Codes 40000-49999 .. 29 Correspondence Language Policy/Example Number - HCPCS/CPT procedure code definition .. 29 Correspondence Language Policy/Example Number - CPT Manual or CMS manual CODING 29 Correspondence Language Policy/Example Number - Mutually exclusive procedures .. 29 Correspondence Language Policy/Example Number - Sequential procedure.

10 29 Page 5 of 53 Medicare - Revision 01/01/2020 Correspondence Language Policy/Example Number CPT separate procedure definition .. 30 Correspondence Language Policy/Example Number - More extensive procedure .. 30 Correspondence Language Policy/Example Number - standards of medical/surgical practice .. 30 Correspondence Language Policy/Example Number - Anesthesia service included in surgical procedure .. 30 Correspondence Language Policy/Example Number - Misuse of Column Two code with Column One code .. 31 Correspondence Language Policy/Example Number Medically Unlikely Edits (UOS).