NCCI Change for Post-procedure Mammograms

on Tuesday, 29 January 2013. All News Items | Coding

The annual update of the National Correct Coding Initiative (NCCI) policy manual for Medicare services is available on the CMS’s NCCI website (see downloads at the bottom of the page). One new feature of this year’s edition is that new and revised text in the electronic manual is italicized in red font. This makes it much easier on the user to determine what has changed with NCCI edits.

As a reminder, CMS developed the NCCI edits is to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits for physicians/practitioners and one table of edits for outpatient hospital services. The Column One/Column Two Correct Coding Edits table and the Mutually Exclusive Edits table have been combined into one table and include code pairs that should not be reported together for a number of reasons explained in the Coding Policy Manual.

One change that we wanted to point out is that post-procedure mammograms should not be separately reported for breast procedures performed with radiologic guidance. Per the NCCI manual, the radiologic guidance includes all imaging required to perform the procedure.

Here is the paragraph from Chapter 9, section D of the NCCI policy manual:

11. If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with radiologic guidance (e.g., 76942, 77012, 77021, 77031, 77032), the physician should not separately report a post procedure mammography code (e.g., 77051, 77052, 77055-77057, G0202-G0206) for the same patient encounter. The radiologic guidance codes include all imaging required to perform the procedure.

Note that although the language indicates “physician”, NCCI polices and edits apply to all practitioners, hospitals, providers, or suppliers unless indicated differently. We encourage hospital providers to be familiar with NCCI edits and the NCCI policy manual. Watch our newsletters for on-going information on some of the NCCI changes for 2013.

Article by Debbie Rubio

Debbie Rubio, BS, MT (ASCP), is the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc. Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system. In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers. You may contact Debbie at This email address is being protected from spambots. You need JavaScript enabled to view it. .

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