The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) Edits Version 24.0. Version 24.0 will be valid for dates of service beginning January 1, 2018 and ending March 31, 2018. Version 24.0 has some significant additions due to changes in CPT codes 97760 and 97761, the addition of CPT codes 97127 and 97763 and the deletion of CPT codes 29582, 29583 and 97532. In addition, there are changes to the edits for CPT codes 97750 and 97755 when billed on the same day as a physical or occupational therapy evaluation or reevaluation. Lastly, I have added many new NCCI edits for the speech therapy evaluation and treatment codes.
To access the Gawenda Seminars & Consulting NCCI Version 24.0 reference sheet for therapy services, click HERE.
It’s not only important that you not only use this reference sheet to assist you to determine when modifier 59 is required to be appended to a CPT code on the claim form, but you need to read the NCCI Policy Manual for Medicare Services. This manual gives additional guidance on NCCI edits, proper billing of CPT codes and the correct use of modifier 59. Some examples of instructions in this manual include the following:
- Gives instructions what equipment must be used to bill CPT code 92597 (Evaluation for voice prosthetic device)
- Gives instructions on speech-language pathologists (SLPs) billing CPT codes 97110, 97112, 97127, 97150 and 97530 on the same day they are billing CPT codes 92507, 92508 and/or 92526.
- Gives instructions on SLPs billing unattended electrical stimulation (G0283) on the same day as CPT code 92526 for dysphagia and swallowing disorders.
- Discusses billing of more than one physical therapy evaluation code or more than one occupational therapy evaluation code on the same date of service.
- Discusses if the same practitioner, who is both a physical therapist and occupational therapist, performs a physical therapy and occupational therapy evaluation on the same day on the same patient.
- Discusses how to bill for physical and/or occupational therapy when performed at the same encounter as cardiac rehabilitation services or pulmonary rehabilitation services.
- Discusses the billing of CPT code 97750 (physical performance test or measurement) and CPT code 97755 ( assistive technology assessment) when performed on the same day as a physical and/or occupational therapy evaluation or reevaluation.
This list is not all inclusive. To access the NCCI Policy Manual for Medicare Services, click HERE.
This Gawenda Seminars & Consulting reference sheet is updated quarterly and is a Gold Member benefit that pays for itself by teaching our members what codes can and can’t be billed on the same date of service, when a CPT code needs modifier 59 appended to it and when modifier 59 is not allowed. The CPT code(s) in column 2 is considered a component of the CPT code in column 1. It is the CPT code in column 2, when provided on the same day as the CPT code in column 1, that requires modifier 59 appended to it on the claim form, if allowed, in order to be paid on the same date of service as the CPT code in column 1.
I hope you enjoyed this article. If you are currently a Gold Member, thank you! If not, this reference sheet, Current News articles, Insurance Links and FAQs on many topics such as the ABN, Maintenance Therapy, L Codes for Orthotics, Progress Reports, Reevaluations, and Therapy Cap will pay for your membership in no time. For additional information on Gold Membership and to join, click HERE.
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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.