Quarterly NCCI PTP Edits for Physicians or Practitioners

$79 / year

The National Correct Coding Initiative, the procedure to procedure (PTP) edits, for physicians/practitioners, quarterly additions contain the information about the changes/additions or deletions in the PTP edit published files for the current quarter. These Quarterly additions to NCCI PTP Edits are to be used for physicians/practitioners for the second quarter of 2018.

Complexity

The Centers for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B claims. The coding policies are based on coding conventions defined in the American Medical Association’s Current Procedural Terminology (CPT) Manual, national and local Medicare policies and edits, coding guidelines developed by national societies, standard medical and surgical practice, and/or current coding practice. NCCI includes three types of edits: NCCI Procedure-to-Procedure (PTP) edits, Medically Unlikely Edits (MUE), and Add-on Code Edits.
NCCI PTP edits prevent inappropriate payment of services that should not be reported together. Each edit has a column one and column two HCPCS/CPT code. If a provider reports the two codes of an edit pair for the same beneficiary on the same date of service, the column one code is eligible for payment but the column two code is denied unless a clinically appropriate NCCI-associated modifier is also reported. The additions, deletions, and modifier indicator quarterly changes to PTP column 1/ column 2 correct coding edits and the PTP mutually exclusive code edits for physicians/practitioners are updated on CMS website.

Date Created

2015-12

Last Modified

2018-04-01

Version

2018-04-01

Update Frequency

Quarterly

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Medical Coding, Medical Billing and Coding Online, Medical Billing Codes, Medical Procedure Codes, Billing and Coding, Physicians/Practitioners, NCCI, NCCI PTP, NCCI Edits, NCCI Codes

Other Titles

National Correct Coding Initiative Coding Editor Changes, PTP Edits Version Update Changes, Quarterly PTP Version Update Changes, NCCI PTP Edits Quarterly Additions, PTP Edits Changes for Physicians/Practitioners

Name Description Type Constraints
Payable_Code5 digit code that indicates the payable code.stringrequired : 1
Non_Payable_CodeColumn 2 contains the code that is not payable with this particular Column 1 code, unless a modifier is permitted and submitted.stringrequired : 1
Modifier_IndicatorIndicates the use of modifier. It indicates the following:integerrequired : 1 enum : Array level : Nominal
StatusAddition, Deletion or Correct Codingstring-
Payable_CodeNon_Payable_CodeModifier_IndicatorStatus
0364TG05150Addition
0365TG05150Addition
0365TG05150Addition
0365TG05150Addition
0365TG05150Addition
0365TG05150Addition
0365TG05150Addition
0365TG05150Addition
0365TG05150Addition
0365TG05150Addition