What is the status of MAC implementation of the NCCI new procedure to procedure edits for the new biopsy codes?
Asked and Answered
August 1, 2019
As of July 1, 2019, service modifiers 59 and XE, XS, XP, and XU may be appended to either Column 1 or Column 2 codes in the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits table, when appropriate.
On March 29, the Centers for Medicare and Medicaid Services National Correct Coding Initiative (CMS/NCCI) announced changes to the column1/column2 sequencing for PTP edits, when appropriate.
The NCCI edit change indicated that Medicare Administrative Contractors (MACs) will allow modifier 59 to be appended on either the Column 1 or Column 2 code of a PTP edit with a modifier indicator of “1”. Additionally, regardless of which of the two paired codes identified in the NCCI PTP Column 1/Column 2 edits receives a 59 modifier, the claim will be paid.
The Academy informed and confirmed from CMS that the MAC’s policy — to strictly require the modifier be appended to the Column 2 code of the PTP code pair — was erroneous. A claim with a modifier appended to the Column 1 code would not be paid.
To correct the error, CMS issued MLN Matters Number: MM11227 (Change Request: 11227) stating that effective July 1, the MACs will accept the modifiers on either Column 1 or Column 2 codes.
Learn more about this issue and test your knowledge in Dermatology World at staging.aad.org/dw/monthly/2019/april/modifier-madness.
