2019 NCCI update impacts billing and coding for spinal procedures, laboratory testing

CMS recently released the 2019 NCCI Policy Manual for Medicare Services, which includes updates to payment policies and coding methodologies effective January 1. The changes impact billing and reporting for spinal arthrodesis procedures and laboratory services.

CMS added new guidance to Chapter 4 for spinal procedures to clarify the reporting of CPT codes 22600-22634 for spinal arthrodesis. It also includes instructions for reporting arthrodesis procedures that span multiple interspaces and spinal regions. 

CMS also revised this section to include a procedure-to-procedure (PTP) edit with column one CPT code 22630 (arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar) and column two CPT code 63056 (arthrodesis, transpedicular approach with decompression of spinal cord, equina and/or nerve root[s], single segment; lumbar). Per the updated manual, the two procedures cannot be reported together at the same spinal level for the same patient encounter.

In addition, the agency added guidance to Chapter 10 of the manual for pathology and laboratory services. Per the manual, a Tier 1 or Tier 2 molecular pathology procedure CPT code should not be reported with a genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis, or proprietary laboratory analysis. CPT code descriptors for Tier 1 and Tier 2 molecular pathology codes include testing for the analyte.

The update includes guidance for reporting laboratory procedures to evaluate multiple genes utilizing a next generation sequencing procedure:

  • If only one procedure is performed, only one unit of service should be reported for the genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis, or proprietary laboratory analysis CPT code.
  • If no CPT code accurately describes the procedure, the lab must report CPT code 81479 (unlisted molecular pathology procedure) with one unit of service.

Throughout the manual, CMS includes section-specific examples to further explain PTP edits and medically unlikely edits (MUE), which are sorted by CPT code section. Written requests for reconsideration of a MUE may be sent to the entity and address identified on the CMS NCCI website.

Editor's note: This article originally appeared on JustCoding.