What do the names of the hospital and practitioner PTP edits mean?
The names of the Hospital PTP Edits or Practitioner PTP Edits show the code range of edits listed in the table, beginning with the first Column 1 or Column 2 code edit in the file and ending with the last Column 1 or Column 2 code edit in the file.
What is the Medicare NCCI procedure to procedure (PTP) edit file?
Since 1996 the Medicare NCCI procedure to procedure (PTP) edits have been assigned to either the Column One/Column Two Correct Coding edit file or the Mutually Exclusive edit file based on the criterion for each edit.
What is the difference between PTP and DME?
The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported. Practitioner services also refers to ambulatory surgical centers. DME refers to provider claims for durable medical equipment.
What is outpatient PTP used in OCE?
Outpatient PTP used in OCE - Effective April 1, 2012 the change was implemented on the CMS website where a single Column One/Column Two Correct Coding edit file contains all active NCCI edits and deleted NCCI edits that previously were contained in the OPPS Mutually Exclusive and Column One/Column Two Correct Coding edit files.
What is the purpose of PTP edit?
The purpose of the PTP edit is to prevent improper payments when incorrect code combinations are reported. The purpose of the MUE edit is to prevent improper payments when services are reported with incorrect units of service. Both the Medicare and Medicaid NCCI programs are managed by the Centers for Medicare & Medicaid Services (CMS); however, ...
What are retroactive deletions for MUE and PTP?
Retroactive deletions for MUE and PTP edits occur for all six methodologies/edits. For example, the PTP edit for codes 77295 3-dimensional radiotherapy plan, including dose-volume histograms and 77300 Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician was deleted, retroactive to Jan. 1, 2016. Deletions occur for various reasons, including when code descriptions are revised or codes are deleted, making the edits no longer applicable. Edits also may be deleted at the request of providers with supporting documentation proving that the edit is not applicable to medical practice. Due to how NCCI edits are released (quarterly), retroactive deletions of PTP edits and other changes that occur mid-quarter do not show until the next quarter is released.#N#Following the correct edit, Medicare or Medicaid, for the claim can mean all the difference between payment and denial. Don’t miss hard-earned revenue by following the wrong edit.
What is a 99394?
99394 Periodic comprehensive preventive medicine reevaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years)#N#99214 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem (s) and the patient’s and/or family’s needs. Usually, the presenting problem (s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family#N#PTP edits for practitioner and ASC services:
Is there a Medicare NCCI edit?
Most edits in the original five Medicaid NCCI methodologies are adopted from the Medicare NCCI. However, not all Medicare NCCI edits in these methodologies have been adopted by the Medicaid NCCI program. Some Medicare NCCI edits are not present at all in Medicaid NCCI and others are present but differ in some way from the corresponding Medicare ...
Does Medicare have NCCI PTP?
Some Medicare NCCI edits are not present at all in Medicaid NCCI and others are present but differ in some way from the corresponding Medicare NCCI edits. Medicaid NCCI PTP edits for durable medical equipment are unique to the Medicaid program – i.e., Medicare NCCI does not have DME NCCI PTP edits. The Medicaid NCCI program has also developed ...
Billing and Coding Advice
A. How do I obtain billing and coding advice from the National Correct Coding Initiative (NCCI) Program?
Procedure-to-Procedure (PTP) Edits
A. What does "Column 1" or “Column 2” mean in the Column 1 / Column 2 NCCI edits table?
Published PTP and MUE Files
A. How do I know what changed in the NCCI PTP and MUE files from quarter to quarter?
