National Correct Coding Initiative (NCCI) Changes for Post-Procedural Mammograms
The January 1, 2013 revision to the NCCI, Version 19.0, contains a new policy regarding post-procedural mammograms when radiologic guidance is used on breast procedures.
According to the NCCI update, post-procedural mammography is now included in all guidance codes used to perform the breast procedure. Thus, when a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with radiologic guidance (e.g. 76942, 77012, 77021, 77031, or 77032), a post procedure mammogram (e.g. 77051, 77052, 77055-77057, or G0202-G0206) would not be eligible for payment under this edit.
For example, the physician performs a breast biopsy and places a metallic localization clip using ultrasound guidance, reported with CPT codes 19103, 19295, and 76942 respectively. The patient then has a mammogram at the same time to confirm placement of the clip (CPT code 77055). Per this new policy, CPT code 77055 would not be separately reported as it would be bundled into the ultrasound guidance CPT code 76942.
The NCCI editing system is a CMS initiative; as such, APS Medical Billing will apply this bundling rule as appropriate to Medicare and Medicaid accounts through its coding process. As an additional safeguard, an edit is being programmed into our billing system to quarantine reports that contain the combination of a radiologic guidance CPT code with a mammography CPT code for additional review.
In working through the wide variety of billing arrangements, APS found payments that we had been missing.