Radiology Coding Alert

Standard policy statements get you inside the decision process

If you don't know what the phrase "Standards of Medical/Surgical Practice" is telling you about an NCCI edit, it's time to study up on the fundamentals. Here's your key to understanding standard policy statements.

What it is: NCCI links a "standard policy statement" to each code pair, and the NCCI Policy Manual, Chapter 1 (available at www.cms.hhs.gov/NationalCorrectCodiNitEd/01_overview.asp), explains the  meaning of these standards.
 
"If you understand the reason certain codes are bundled, you can better determine what circumstances might warrant unbundling those services with a modifier," says William Dettwyler, MT-AMT, president of consulting firm Codus Medicus.

Here are some of the most common statements:

1. HCPCS/CPT Procedure Code Definition

NCCI lists this policy statement when one code is part of another based on the descriptor language.

In many cases, that's because an indented code includes all of the service described by the main entry preceding a semicolon.

NCCI offers this example:
 
• 70120 -- Radiologic examination, mastoids; less than three views per side

• 70130 -- ... complete, minimum of three views  per side.

For a complete radiologic exam of the mastoids, you should report 70130. You don't need to report 70120 in addition to 70130, because the descriptor for 70130 (at least three views per side) includes the services described by 70120 (less than three views per side).

2. Coding Manual Instruction/Guideline

At the start of major sections or subsections or preceding or following a series of codes, CPT includes  cross-references and guidance to assist providers in selecting the appropriate codes. NCCI forms edit pairs when reporting two codes together would be contrary to these CPT instructions.
 
3. Misuse of Column 2 Code With Column 1 Code

When CMS identifies codes from different parts of CPT that providers might mistakenly think describe a similar service, an NCCI edit will prohibit the code pair under the "misuse of column 2 code with column 1 code" policy.
 
4. Standards of Medical/Surgical Practice

Each CPT code includes generic activities that the provider must always perform to accomplish the procedure. You can't separately code an activity that is a standard part of a particular procedure.

The NCCI manual offers this example: "Procurement of upper extremity (brachial) Doppler study in addition to lower extremity Doppler study in order to obtain an 'ankle-brachial index' (ABI). The upper extremity Doppler would not be separately reported."