CMS PTP Coding Edits
Guidance for CMS consolidating two edit files into the Column One/Column Two Correct Coding edit file. Separate consolidations occurred for the two practitioner PTP edit files and the two PTP edit files used for OCE.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 31, 2020
Since 1996 the Medicare NCCI procedure to procedure (PTP) edits have been assigned to either the Column One/Column Two Correct Coding edit file or the Mutually Exclusive edit file based on the criterion for each edit. The Mutually Exclusive edit file included edits where two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations. All other edits were assigned to the Column One/Column Two Correct Coding edit file. There are important changes to these files described below.
In order to simplify the use of PTP edit files, CMS consolidated the two edit files into the Column One/Column Two Correct Coding edit file. Separate consolidations occurred for the two practitioner PTP edit files and the two PTP edit files used for OCE. This change occurred for PTP edits in NCCI version 18.1 scheduled for April 1, 2012. After this date, it will only be necessary to search the Column One/Column Two Correct Coding edit file for active or previously deleted edits. Effective April 1, 2012, CMS will no longer publish a Mutually Exclusive edit file on its website for either practitioner or outpatient hospital services since all active and deleted edits will appear in the single Column One/Column Two Correct Coding edit file on each website. The edits previously contained in the Mutually Exclusive edit file were NOT deleted but were moved to the Column One/Column Two Correct Coding edit file.
Practitioner PTP - In NCCI version 18.1 for practitioners scheduled for April 1, 2012, all edits in the Mutually Exclusive edit file were moved to the Column One/Column Two Correct Coding edit file with the same implementation and, if relevant, deletion date as the edits have in the mutually exclusive edit file. These edits were not deleted from NCCI but were moved to the Column One/Column Two Correct Coding edit file. The net result is that the NCCI version 18.1 Column One/Column Two Correct Coding edit file l contains all active PTP edits and deleted PTP edits that previously were contained in the Mutually Exclusive and Column One/Column Two Correct Coding edit files. The CMS website has a single Column One/Column Two Correct Coding edit file for practitioner PTP.
Outpatient PTP used in OCE - Effective April 1, 2012 the change was implemented on the CMS website where a single Column One/Column Two Correct Coding edit file contains all active NCCI edits and deleted NCCI edits that previously were contained in the OPPS Mutually Exclusive and Column One/Column Two Correct Coding edit files. These edits were not deleted from the OCE NCCI files but were moved to the Column One/Column Two Correct Coding edit file.
As of October 8, 2014, the PTP text files have been modified for Section 508 compliancy purposes. They now include headers and are tab delimited.
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