Your Guide to CCI Trends for the End of the Year

Mon, Sep 30, 2019 --

CPT Codes, Medicare

On Oct. 1, 2019, there will be 118 new National Correct Coding Initiative (NCCI or CCI) edits for physicians reporting to Medicare. Keep your coding up to date and in compliance with the edits with this quick overview featuring path/lab, allografts, venous procedures, and radiation oncology.

Keep in mind: The edits we’re talking about here are Medicare practitioner procedure to procedure (PTP) edits. Medicare updates these edits each quarter.

Look Before You Lab (See What I Did There?)

Most of the CCI edit additions for this quarter are related to lab and pathology codes. Not all of the edits are below, but these are the major areas to watch:

  • Seventy-three new edits put 0082U (Drug test(s), definitive, 90 or more drugs or substances, definitive chromatography with mass spectrometry, and presumptive, any number of drug classes, by instrument chemistry analyzer (utilizing immunoassay), urine, report of presence or absence of each drug, drug metabolite or substance with description and severity of significant interactions per date of service) in the column 1 position. The column 2 codes are almost all 80000-range codes, but you’ll also find definitive drug test codes G0480-G0483 and G0659 in the column 2 spot. The modifier indicators vary, so check to confirm whether you can use a modifier to override an individual edit. A 0 means you can’t override the edit. A 1 means you may override the edit by using a modifier when documentation and clinical circumstances support reporting the codes separately.
  • Code 81204 lands in the column 2 spot for two new edits with 81173 and 81174. The modifier indicator is 1 for each of these edits. All of the codes represent androgen receptor gene analysis.
  • Two is also the number of new edits with 81184 in the column 2 spot. You’ll find 81185 and 81186 in column 1. Again the modifier indicator is 1. These codes apply to CACNA1A gene analysis.
  • Five new edits create different bundles for FXN gene analysis codes 81284-81286 and 81289. The modifier indicator for all of these edits is 1:
    • 81285 is the column 1 code in edits with 81284, 81286, and 81289
    • 81284 is the column 2 code in edits with 81286 and 81289.
  • Code 0053U (Oncology (prostate cancer), FISH analysis of 4 genes ) is in column 2 for two new edits with 81321 for PTEN gene analysis and 81539 for oncology biochemical assay.

Understand 20 New Edits for Allograft Code +20933

There’s a silver lining to the 20 new edits CCI adds for +20933 (Allograft, includes templating, cutting, placement and internal fixation, when performed; hemicortical intercalary, partial (ie, hemicylindrical) (List separately in addition to code for primary procedure)).

Every one of these new edits will help you adhere to the CPT® guideline with +20933 that forbids you from reporting that code with the codes in the column 1 position in the new edits.

Allograft coders also should note that CCI deletes 20 edits with +20934 (… intercalary, complete (ie, cylindrical) (List separately in addition to code for primary procedure)) in the column 2 spot of edits with the exact same codes +20933 will now be bundled into.

Examples of column 1 codes include 20955 (Bone graft with microvascular anastomosis; fibula) and 28107 (Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with allograft).

Verify Before Reporting Vein Codes

There are a handful of changes for 3647x codes, which represent venous procedures.

First, there are three new edits with modifier indicator 1:

  • Laser endovenous ablation therapy code 36478 (first vein) is in the column 1 position for edits with 36470 and 36471 for injection of sclerosant
  • Laser endovenous ablation therapy code +36479 (subsequent veins) is in column 1 for an edit with 36471.

Second, there are some modifier indicator changes. For all of the edit pairs below, the modifier indicator will be 0 starting Oct. 1:

  • +36476 (radiofrequency endovenous ablation therapy), 76937 (ultrasound guidance for vascular access)
  • +36479, 76937
  • +36479, 76942 (ultrasonic guidance for needle placement).

Remember These Radiation Oncology Edits

Finally, you’ll find four new edits bundling teletherapy isodose plan codes 77306 and 77307 into G6015 (Intensity modulated treatment delivery …) and G6016 (Compensator-based beam modulation treatment delivery …). All of these edits have a modifier indicator of 1.

What About You?

Do any of these CCI edits affect your claims? Do you like when CCI creates edits that help you follow CPT® rules, like the edits for +20933?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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