General

General Question for the Week of March 1, 2021

General Compliance Question of the Week

Question:

Can you explain the differences between PTP, MUE, and AOC edits mentioned in last week’s question?

Answer:

A PTP edit identifies code pairs that are not separately billable when coded on the same date of service. An MUE identifies services with billed units greater than what is considered clinically appropriate. An AOC edit identifies a service that, with rare exceptions, should be performed in conjunction with another primary service by the same practitioner. The PTP edits and MUE limitations are updated quarterly. The purpose of the edits is to ensure appropriate coding and billing of services and to guide proper payment of these services. The NCCI is updated through the course of the year and re-published each quarter with these changes. It is imperative that all practices and facilities required to bill under Medicare possess a current version of the material. The NCCI is Medicare’s most comprehensive bundling policy.