Coding Corner: What are NCCI PTP edits, and what do they mean to me?

Kimberly Levinson, MD, MPH

The National Correct Coding Initiative (NCCI) was developed by the Centers for Medicare and Medicaid Services to help ensure correct coding methodologies and to prevent improper coding. Specifically, Procedure-to-Procedure (PTP) edits aim to prevent utilization of multiple codes that bill for the same services. There is a manual published online which serves as a reference in this regard and can be found here.

Most recently, PTP coding edits were updated to a two-column system, whereby a table is utilized to report codes that cannot be billed together. In these tables, column 1, or column A, shows the payable code (which is the code with higher RVU value), and column 2, or column B, shows the second code. The next three columns give information on the dates of PTP edits, the sixth column, or column F, identifies whether those codes can be paid together, and the seventh column explains why a code can or cannot be billed together.

Example:

Below is a PTP table specific to Gynecologic Oncology codes. In the highlighted row, you can see that the first code is CPT 58953, debulking surgery including total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and radical dissection for debulking. In the second column, the code 58150 is listed which is the code for total abdominal hysterectomy, with or without removal of the tubes and ovaries. Listed in column F is the number 0, which indicates that these 2 codes are incompatible and cannot be billed together. The reason, listed in column G, is “more extensive procedure”; in other words, CPT 58953 is inclusive of those procedures included in the code 58150, but is more extensive and thus, these 2 codes cannot be billed together.

If a 1 is listed in column F, this indicates that these codes may be able to be billed together, however, a modifier will need to be utilized.

Kimberly Levinson, MD, MPH, is an Associate Professor of Gynecologic Oncology at Johns Hopkins University in Baltimore, MD.