lmz0330
Networker
Has anyone one else noticed incorrect edits for billing 22633 with 63052? i am seeing these in Epic and Codify
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Wiki 63052 with 22633 Edits
- Thread starter lmz0330
- Start date
There is an NCCI edit between 22633 and 63052 effective 7/1/2023.
I found it directly on the CMS website in the PTP edits: https://www.cms.gov/medicare-medica...e/medicare-ncci-procedure-procedure-ptp-edits
cgaston
True Blue
KZA had an article about this at the end of June:
"KZA contacted the relevant specialty societies who. in turn, immediately contacted Medicare's NCCI officials. The outcome? NCCI admits that this edit was published in error and will be rescinded as soon as possible, but likely not until the next quarterly publication of NCCI edits on January 1, 2024."
What does this mean for your practice?
What should you do?
"KZA contacted the relevant specialty societies who. in turn, immediately contacted Medicare's NCCI officials. The outcome? NCCI admits that this edit was published in error and will be rescinded as soon as possible, but likely not until the next quarterly publication of NCCI edits on January 1, 2024."
What does this mean for your practice?
- Medicare payors and payors who follow Medicare edits will likely deny codes 63052 and 63053 when reported with codes 22630, 22633, 22632, 22634 respectively effective 7/1/23.
What should you do?
- Continue to report 63052 and 63053 with the lumbar interbody arthrodesis codes listed above whenever additional decompression is documented at the same interspace
- Tag and track all cases that have this code combination
- When NCCI rescinds (deletes) the edit, reimbursement will be retroactive to 7/1/23. Your practice will need to identify all cases billed between 7/1/23 and the edit deletion for either resubmission for payment or possibly automatic reimbursement for all cases"
jalabergeron
Contributor
I just came across this issue today as my 3M has not updated. I found this link: https://www.cms.gov/medicare/coding-billing/ncci-medicare
Effective July 1, 2023, CMS implemented bypassable NCCI PTP edits between Column One codes 22630, 22632, 22633 and 22634, and Column Two codes 63052 and 63053. CMS will delete these edits in the October 1, 2023 edit files. The MACs will adjust claims with dates of service between July 1, 2023 and October 1, 2023 that were denied due to lack of a modifier to allow payment. A provider may also choose to use the MAC appeals process if it does not wish to wait for the adjustment to occur, or it can wait to submit its claims until CMS implements the change.