Knowledge Base Article

Q:

We are getting a CCI edit between our nuclear medicine bone scans and the radiopharmaceutical we always use in conjunction with bone scans (technetium medronate / MDP). The edit is telling us we cannot report the bone scan CPT code and HCPCS code A9503 for the MDP on the same date of service – with or without a modifier. Can you explain?

A:

This is a new CCI edit that became effective January 1, 2020. We sent actual patient examples to NCCI asking for clarification. We received notification from NCCI that, after review of the issue, CMS has made a decision to delete the January 1, 2020 edits in the table below. Review the table carefully, as the changes include radiopharmaceuticals besides A9503.

The changes will be retroactive to January 1, 2020 and will be implemented as soon as technically possible. Providers may choose to delay submission of claims for deleted edits until after the implementation of the replacement edit file with retroactive date of January 1, 2020.

Providers may also choose to appeal claims denied due to the PTP edits to the appropriate MAC including supporting documentation or resubmit claims denied due to the PTP edits after the implementation of the replacement edit file with January 1, 2020 retroactive date, as permitted by the MAC.