NCCI Quarterly Update

You’ll find minimal changes to the Medicare National Correct Coding Initiative (NCCI) code files this fourth quarter 2023. The update, effective Oct. 1, includes just three changes to code edits in both the practitioner and hospital procedure-to-procedure (PTP) edits. If your practitioners provide these services, however, the changes are a big deal.

CMS Updates NCCI Edit Files

In the Practitioner PTP Edit files, you’ll find the following code pairs have revised edits:

Column 1            Column 2

31241                   30802

49614                   49622

49615                   49622

In the Hospital PTP Edit files, you’ll find the following code pairs have revised edits:

Column 1            Column 2

31241                   30802

49614                   49622

49615                   49622

Here’s What Has Changed

For the following code pair, the rationale is “Misuse of column two code with column one code.”

31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery

30802 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)

What’s changing: A modifier is now allowed to override this edit, when appropriate.

For the following code pairs,

49614 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, incarcerated or strangulated

49615 … ; 3 cm to 10 cm, reducible

49622 Repair of parastomal hernia, any approach (ie, open, laparoscopic, robotic), initial or recurrent, including implantation of mesh or other prosthesis, when performed; incarcerated or strangulated

What’s changing: The rationale is changing from “mutually exclusive procedures” to “Misuse of column two code with column one code.”