American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

CMS Corrects NCCI Errors Retroactive to January 1, 2017

In January, a NewsScope article informed members that National Correct Coding Initiative (NCCI) edits for the new moderate sedation (MS) Current Procedural Terminology (CPT) codes 99151–99153 were incorrectly applied in the Centers for Medicare & Medicaid Services (CMS) billing software for several procedure codes and that the incorrect edits would not allow bypass with NCCI-associated modifiers. The surgical codes affected by this error include dialysis circuit (36901–36909); transluminal balloon angioplasty (37246–37249); transoral esophagogastric fundoplasty (43210); and anorectal exam under anesthesia (45990). The errors have been corrected and are retroactive to January 1, 2017.

CMS indicated they would correct these errors in the April 1 version of the software and that physicians who perform both MS and the affected procedures could delay claim submission until the software was updated or resubmit denied claims after the software update.

If you held back claims for these codes, you should submit them now. Also, if you submitted claims that were denied, you should resubmit.

View a downloadable list of these and other 2017 corrections on the CMS website.

Read the full issue of NewsScope.