2024 NCCI Updates

Each year, CMS updates the National Correct Coding Initiative (NCCI) Policy Manual. The NCCI edits themselves are updated quarterly. However, the manual serves as a resource of CMS’s reasoning for the edits and further explanation of edits. In this coding tip, some of the changes in the NCCI Policy Manual for 2024 will be reviewed briefly. See the highlighted text for updates below. Please refer to the entire manual which is located here: https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual#archive For all chapters, there were some abbreviations added to the manual in the Acronyms Chapter such as MCPM-Medicare Claims Processing Manual. They also added “Professional” after CPT to indicate the CPT Professional code book. CMS also added the specific X modifiers as applicable; “Modifiers 59 or XE, XP, XS, XU”

Chapter 1 General

E. Modifiers and Modifier Indicators
Each NCCI PTP edit has an assigned Correct Coding Modifier Indicator (CCMI). A CCMI of “0” indicates that NCCI PTP-associated modifiers cannot be used to bypass the edit. A CCMI of “1” indicates that NCCI PTP-associated modifiers may be used to bypass an edit under appropriate circumstances. A CCMI of “9” indicates that the use of NCCI PTP-associated modifiers is not specified. This indicator is used for all code pairs that have a deletion date that is the same as the effective date. This indicator prevents blank spaces from appearing in the indicator field.

Q. Gender-Specific Procedures
Some HCPCS/CPT codes includes a sex assignment descriptor. HCPCS/CPT codes specific for patients assigned female at birth should generally not be reported with HCPCS/CPT codes for patients assigned male at birth or vice versa. For example, CPT code 53210 describes a total urethrectomy including cystostomy in a patient assigned female at birth, and CPT code 53215 describes the same procedure in a patient assigned male at birth.

An MUE or the lack of an MUE, does not necessarily indicate coverage status of a HCPCS/CPT code. The NCCI program does not establish medical necessity or payment policy.

Chapter V Respiratory, Cardiovascular, Hemic and Lymphatic

10. If laryngoscopy is required for elective or emergency placement of an endotracheal tube, the laryngoscopy is not separately reportable. CPT code 31500 describes an emergency endotracheal intubation procedure and shall not be reported when an elective intubation is performed. For example, if intubation is performed in a rapidly deteriorating patient who requires mechanical ventilation, a separate HCPCS/CPT code may be reported for the emergent intubation. The medical record must document the necessity for emergent intubation.

Chapter VI Digestive

4.If a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair (e.g., CPT codes 15778, 49591-49596, 49613-49618, 49621-49623) is not separately reportable. The hernia repair is separately reportable if it is performed at a site other than the incision for an open or laparoscopic abdominal procedure, and is medically reasonable and necessary. An incidental hernia repair shall not be reported separately. (CPT codes 49560, 49566, 49652, and 49657 were deleted January 1, 2023.)

5. Subsection deleted, January 1, 2024.

Chapter VIII Endocrine, Nervous, Eye and Ocular Adnexa

2. Iridectomy and/or anterior vitrectomy may be performed in conjunction with cataract extraction. If an iridectomy is performed to complete a cataract extraction, it is an integral part of the procedure and is not separately reportable. Similarly, the minimal vitreous loss occurring during routine cataract extraction does not represent a vitrectomy and is not separately reportable. If an iridectomy or vitrectomy that is separate and distinct from the cataract extraction is performed at the same patient encounter, the iridectomy and/or vitrectomy may be reported separately with an NCCI PTP-associated modifier.

If a trabeculectomy that is separate and distinct from the cataract extraction is performed at the same encounter, the trabeculectomy may be reported separately with an NCCI PTP-associated modifier. The medical record must document the distinct medical necessity for each procedure. For example, if a patient with glaucoma requires a cataract extraction, and a trabeculectomy is the appropriate treatment for the glaucoma, the trabeculectomy may be separately reportable. However, performance of a trabeculectomy as a preventative service for an expected transient increase in intraocular pressure postoperatively, without other evidence for glaucoma, is not separately reportable.

Chapter XI Evaluation and Management Services

C. Psychiatric Services
HCPCS codes G0396 and G0397 describe alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services. These codes shall not be reported separately with an E&M, medicine, psychiatric diagnostic, or psychotherapy service code on the same day. E&M, medicine, psychiatric diagnostic, or psychotherapy services may include assessment and/or intervention of alcohol or substance abuse based on the patient’s clinical presentation, therefore HCPCS G0396 or G0397 shall not be additionally reported. HCPCS codes G0396 and G0397 describe services that are similar to those described by CPT codes 99408 and 99409 that are not covered under the Medicare program. If an E&M, medicine, psychiatric diagnostic, or psychotherapy service is related to a problem that may require evaluation and management duplicative of the HCPCS code (e.g., G0442 (Annual alcohol misuse screening, 15 minutes), G0443 (Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes), and G0444 (Annual depression screening, 15 minutes)), the HCPCS code is not separately reportable. For example, if a patient presents with symptoms suggestive of depression, the provider/supplier shall not report G0444 in addition to the E&M, medicine, psychiatric diagnostic, or psychotherapy service code. The time and work effort devoted to the HCPCS code screening, intervention, or counseling service must be distinct and separate from the time and work of the E&M, medicine, psychiatric diagnostic, or psychotherapy service. Both services may occur at the same patient encounter.

The information contained in this post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.