Know What’s New in the 2020 Medicare NCCI Manual

woman at office computerMedicare has posted the 2020 National Correct Coding Initiative (NCCI) manual, with the updates helpfully marked in red, as usual. Here are some hints on what you’ll find in the latest version.

Review Radiology Section’s SPECT/Planar and Oncology Updates

First up are changes in the radiology services section of the NCCI manual, which you’ll find in Chapter 9.

SPECT/planar combo codes: Subsection E covers nuclear medicine and includes an update about proper coding when there are both SPECT and planar studies. In short, if there’s a single code that covers both SPECT and planar imaging (and possibly other modalities) that’s appropriate for your case, use that code. In other cases, it’s unlikely that using both planar and SPECT is medically necessary. Here is the official wording.

  • 2019: “2. Single photon emission computed tomography (SPECT) studies represent an enhanced methodology over standard planar nuclear imaging. When a limited anatomic area is studied, there is no additional information procured by obtaining both planar and SPECT studies. While both represent medically acceptable imaging studies, a SPECT study of a limited area is not separately reportable with a planar study of the same area. When vascular flow studies are obtained using planar technology in addition to SPECT studies, the appropriate CPT® code for the vascular flow study shall be reported, not the flow, planar and SPECT studies. In cases where planar images must be procured because of the size of the scanned area (e.g., bone imaging), both planar and SPECT scans may be necessary and reported separately.”
  • 2020: “2. Single photon emission computed tomography (SPECT) studies represent an enhanced methodology over standard planar nuclear imaging. Several nuclear medicine CPT® codes describe combinations of planar, single photon emission computed tomography (SPECT), flow imaging, or SPECT with CT imaging for evaluation of a specific anatomic area. Unless specified by a single code that combines two or more imaging modalities, no additional information is procured by obtaining both planar and SPECT studies for a limited anatomic area.”

Superficial radiation treatment: Subsection F about radiation oncology also includes a change that’s worth noting, covering when you may report evaluation and management (E/M) codes. The 2020 version adds this wording at the end of number 1: “E&M services (i.e., 99211-99213) in addition to an initial visit E&M service may be reported with CPT® code 77401 (Radiation treatment delivery, superficial and/or ortho voltage ) with modifier 25 [Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service] for the purpose of reporting physician services for certain aspects of radiation therapy planning.”

This new wording is similar to a change to Medicare Claims Processing Manual, Chapter 12, Section 30.6.17 that SuperCoder blog covered in August. That wording states you can report 99211-99213 with modifier 25 appended “for the purpose of reporting physician work associated with radiation therapy planning, radiation treatment device construction, and radiation treatment management when performed on the same date of service as superficial radiation treatment delivery.”

Make Time for This Molecular Pathology Checklist Item

Chapter 10 of the NCCI manual covers pathology and laboratory services. The molecular pathology subsection (F) adds the same wording in three different places. Check numbers 7, 8, and 9 for the addition of “Procedures reported together must be both medically reasonable and necessary (e.g., sequencing of procedures) and ordered by the physician who is treating the beneficiary and using the results in the management of the beneficiary’s specific medical problem.”

Before you report a molecular pathology code with another code (including another molecular pathology code), be sure you’ve checked the NCCI edits for the codes and evaluate the combination in light of the new words in the NCCI manual.

Know Which X{EPSU} Modifier May Apply

One of the trends you’ll notice in the 2020 version of the NCCI manual is the addition of X{EPSU} modifiers alongside references to modifier 59 (Distinct procedural service).

Pain management example: Chapter 2 adds the reference in this passage to modifier XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service): “If an epidural injection is not used for operative anesthesia but is used for postoperative pain management, modifier 59 or XU may be reported to indicate that the epidural injection was performed for postoperative pain management rather than intraoperative pain management.”

Lesion removal example: Chapter 3, which focuses on the integumentary system, adds the reference to XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) noted here: “If multiple lesions are removed separately, it may be appropriate (depending upon the code descriptors) for the procedures to report multiple HCPCS/CPT® codes using anatomic modifiers or modifier 59 or XS to indicate different sites or lesions.”

Small Changes Add Up, Too

As you may know, CMS awarded the NCCI contract to a new contractor in early 2019. Many of the smaller revisions in the 2020 NCCI manual appear to be housekeeping-type revisions by the new contractor, like capitalizing the first letter of code descriptors. You’ll also see the use of new abbreviations like AOC for add-on code.

What About You?

Do you use the NCCI manual when making coding decisions?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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