General Question for the Week of July 9, 2018

General Compliance Question of the Week

Question:

I know that providers are supposed to check the PTP edits before submitting Medicare claims, but what about the mutually exclusive edits?

Answer:

Transmittal R4080CP (issued June 29, 2018) announces the next update of the national correct coding initiative (NCCI) will take effect on October 1. In that transmittal, the Centers for Medicare & Medicaid Services (CMS) state that it is only necessary to search the column one/column two correct coding edit file for active or previously deleted edits. CMS no longer publishes a mutually exclusive edit file on its website for either practitioner or outpatient hospital services, since all active and deleted edits will appear in the single column one/column two correct coding edit file. The edits previously contained in the Mutually Exclusive edit file are NOT being deleted, just moved.

This information can be found at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4080CP.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.