CORRECT CODING INITIATIVE’S 81001 Ncci Correspondence Language Manual

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NATIONAL CORRECT CODING INITIATIVE’S
(NCCI)
GENERAL CORRESPONDENCE LANGUAGE
AND
SECTION-SPECIFIC EXAMPLES
(FOR NCCI PROCEDURE TO PROCEDURE (PTP)
EDITS AND MEDICALLY UNLIKELY EDITS
(MUE))
EFFECTIVE: April 1, 2014*

*INCLUDES 2014 HCPCS/CPT CODES

Current Procedural Terminology (CPT) codes, descriptions and other
data only are copyright 2013 American Medical Association. All rights
reserved.
CPT® is a registered trademark of the American Medical Association.
Applicable FARS\DFARS Restrictions Apply to Government Use.
Fee schedules, relative value units, conversion factors and/or related
components are not assigned by the AMA, are not part of CPT, and
the AMA is not recommending their use. The AMA does not directly
or indirectly practice medicine or dispense medical services. The
AMA assumes no liability for the data contained or not contained
herein.

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TABLE OF CONTENTS
Section

Page

Introduction

General Correspondence Language for NCCI PTP Edits
Standard preparation/monitoring services for anesthesia
HCPCS/CPT procedure code definition
CPT Manual or CMS manual coding instruction
Mutually exclusive procedures
Sequential procedure
CPT “Separate procedure” definition
More extensive procedure
Gender-specific procedures
Standards of medical/surgical practice
Anesthesia service included in surgical procedure
Laboratory panel
Deleted/modified edits for NCCI
Misuse of column two code with column one code
General Correspondence Language for Medically Unlikely Edits (MUE)
(Units of Service)
Medically Unlikely Edits (MUE) (Units of Service)
Deleted/modified edits for MUE

9
9
9
10
10
10
10
11
11
11
11
12
12

12
13

Section-specific examples for Anesthesia Services
(CPT codes 00000 - 09999)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

14-15
15

Section-specific examples for Surgery: Integumentary System
(CPT Codes 10000 - 19999)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

16-18
18

Section-specific examples for Surgery: Musculoskeletal System
(CPT Codes 20000 - 29999)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

19-21
21

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TABLE OF CONTENTS (Continued)
Section

Page

Section-specific examples for Surgery: Respiratory, Cardiovascular,
Hemic and Lymphatic Systems (CPT Codes 30000 - 39999)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

22-24
24

Section-specific examples for Surgery: Digestive System
(CPT Codes 40000 - 49999)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

25-27
27

Section-specific examples for Surgery: Urinary, Male Genital,
Female Genital, Maternity Care and Delivery Systems
(CPT Codes 50000 - 59999)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

28-30
30

Section-specific examples for Surgery: Endocrine, Nervous, Eye
and Ocular Adnexa, Auditory Systems (CPT Codes 60000 - 69999)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

31-32
33

Section-specific examples for Radiology Services
(CPT Codes 70000 - 79999)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

34-36
36

Section-specific examples for Pathology and Laboratory Services
(CPT Codes 80000 - 89999)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

37-38
39

Section-specific examples for Medicine, Evaluation and Management Services
(CPT Codes 90000 - 99999)
NCCI PTP edits
40-42
Medically Unlikely Edits (Units of Service)
42

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TABLE OF CONTENTS (Continued)
Section

Page

Section-specific examples for CPT Category III Codes
(Temporary CPT Codes for Emerging Technology,
Services, and Procedures) (CPT Codes 0000T – 0999T)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

43-45
45

Section-specific examples for Supplemental Services
(HCPCS Level II Codes A0000 - V9999)
NCCI PTP edits
Medically Unlikely Edits (Units of Service)

46-47
48

Examples of Deleted National Correct Coding Initiative (NCCI) Edits
and Medically Unlikely Edits (MUE)
Deleted NCCI PTP Edit Example
Deleted MUE Example

49
49

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Introduction
The Centers for Medicare and Medicaid Services (CMS) established the National
Correct Coding Initiative (NCCI) program to ensure the correct coding of services. The
NCCI program includes two types of edits: NCCI edits (also known as Procedure to
Procedure (PTP) edits) and Medically Unlikely Edits (MUEs) (Units of Service).
NCCI PTP edits prevent inappropriate payment of services that should not be reported
together. Each PTP edit has a column one and column two HCPCS/CPT code and a
Correct Coding Modifier Indicator (CCMI). If a provider reports the two codes of an edit
pair for the same beneficiary on the same date of service and the CCMI is 0, the column
two code is denied, and the column one code is eligible for payment. If the CCMI is 1
and if an NCCI-associated modifier is used because the appropriate clinical
circumstances are met, the NCCI PTP edit will be bypassed. If the CCMI is 1 and an
NCCI-associated modifier is not used, the column two code is denied.
Medically Unlikely Edits (MUEs) prevent payment for an inappropriate number/quantity
of the same service on a single day. An MUE for a HCPCS/CPT code is the maximum
number of units of service (UOS) under most circumstances reportable by the same
provider for the same beneficiary on the same date of service.
Each NCCI PTP edit and each MUE has a corresponding Correspondence Language
Example Identification Number (CLEID). The CLEID provides information to Medicare
claims processing contractors about the rationale for these edits that can be used to
help educate providers about the edits. For example, a Medicare contractor may refer
to the CLEID when responding to an inquiry about a specific NCCI PTP edit or MUE or
to an appeal of a claim line that was denied due to an edit. The CLEID that
corresponds to each NCCI PTP edit is currently not included in the NCCI PTP edit files
that are posted on the CMS Medicare NCCI web site. That information is currently only
available to the Medicare contractors. The following information provides guidance to
providers when a CLEID is referenced in a response from a Medicare contractor.
The CLEID is formatted as follows: DD.EEEEEEEEE.
DD identifies the general policy that provides the rationale for the edit. There are
fourteen categories of general policies for NCCI PTP edits. They are:
1.
2.
3.
4.
5.
6.
7.

Standard preparation/monitoring services for anesthesia
HCPCS/CPT procedure code definition
CPT Manual or CMS manual coding instruction
Mutually exclusive procedures
Sequential procedure
CPT “Separate procedure” definition
More extensive procedure

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8.
9.
10.
11.
12.
13.
14.

Reserved for future use
Gender-specific procedures
Standards of medical/surgical practice
Anesthesia service included in surgical procedure
Laboratory panel
Deleted/modified edits for NCCI
Misuse of column two code with column one code

There are two categories of general policies for MUEs. They are:
15. Medically Unlikely Edits (MUEs) (Units of Service)
16. Deleted/modified edits for MUE

Detailed information about each of the general policies can be found in individual
sections of Chapter I of the National Correct Coding Initiative Policy Manual for
Medicare Services which is posted on the CMS Medicare NCCI web site. The general
correspondence language relating to each of these policy categories is found on pages
9 – 13 of this Manual.
EEEEEEEEE identifies the section of this Manual to use for a specific example related
to the policy statement. For example, if EEEEEEEEE is 10000, the example refers to
column one CPT codes from the 10000 series of codes in the CPT Manual. For NCCI
PTP edits with a column one HCPCS code of A0000 – V9999, the entry for
EEEEEEEEE is “A – V” rather than a number.
When developing correspondence using the “Correspondence Language Manual",
Medicare claims processing contractors utilize two paragraphs from this Manual:
•

The first paragraph is the relevant "General Correspondence Language"
statement as identified by DD. The column one and column two codes of the edit
pair in question are entered in appropriate spaces in that paragraph.

•

The second paragraph is the relevant section-specific example as identified by
EEEEEEEEE.

For example, for the NCCI PTP edit with a column one code of 37760 and a column two
code of 15271, the CLEID is 2.30000. An individual providing an explanation of this edit
would use two paragraphs from the "Correspondence Language Manual". The first
paragraph would be the paragraph "2. HCPCS/CPT procedure code definition" from the
"General Correspondence Language" portion of this Manual (page 9). The second
paragraph would be selected from the "Section Specific Examples" for the 30000 series
of codes, “Respiratory, Cardiovascular, Hemic and Lymphatic Systems”. The
correspondent would select the example identified as "Correspondence Language
Policy/Example Number 2.30000" (page 22). The two paragraphs would be:
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The HCPCS/CPT procedure code definition, or descriptor, is based upon
contemporary medical practice. When a HCPCS/CPT code is submitted to
Medicare, all services described by the descriptor should have been performed.
Because some HCPCS/CPT codes describe complex procedures with several
components which may under certain circumstances be performed
independently, some of the component procedures have their own HCPCS/CPT
codes. If a HCPCS/CPT code is reported along with other HCPCS/CPT codes
that are components of the descriptor of the first code, only the first code should
be reported. The HCPCS/CPT code 37760 descriptor includes the service
described by the descriptor of HCPCS/CPT code 15271. Thus, based upon the
HCPCS/CPT code descriptors HCPCS/CPT code 15271 is bundled into
HCPCS/CPT code 37760.
For example, the code descriptor for CPT code 33612 is “Repair of double outlet
right ventricle with intraventricular tunnel repair; with repair of right ventricular
outflow tract obstruction” and the code descriptor for CPT code 33611 is “Repair
of double outlet right ventricle with intraventricular tunnel repair;”. Therefore,
based upon the code descriptors the procedure described by CPT code 33611 is
a component of the procedure described by CPT code 33612, and CPT code
33611 is bundled into CPT code 33612.

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National Correct Coding Initiative’s
General Correspondence Language
1. Standard preparation/monitoring services for anesthesia: Anesthesia
services require certain services to prepare a patient prior to the administration of
anesthesia and to monitor a patient during the course of anesthesia. Additionally, when
monitored anesthesia care (MAC) is provided, the attention devoted to patient
monitoring is of a similar level of intensity so that general anesthesia may be
established if needed. The specific services necessary to prepare and monitor a patient
vary among procedures based upon the extent of the surgical procedure, the type of
anesthesia (general, MAC, regional, local, etc.), and the surgical risk. The physician
determines which preparation and monitoring services are utilized for an anesthesia
procedure. These services are included in the anesthesia service. Accordingly, when
reporting the anesthesia service code, HCPCS/CPT code_____ (the column one
HCPCS/CPT code), the services described by HCPCS/CPT code ______ (the column
two HCPCS/CPT code) are included in the anesthesia service.
2. HCPCS/CPT procedure code definition: The HCPCS/CPT procedure code
definition, or descriptor, is based upon contemporary medical practice. When a
HCPCS/CPT code is submitted to Medicare, all services described by the descriptor
should have been performed. Because some HCPCS/CPT codes describe complex
procedures with several components which may under certain circumstances be
performed independently, some of the component procedures have their own
HCPCS/CPT codes. If a HCPCS/CPT code is reported along with other HCPCS/CPT
codes that are components of the descriptor of the first code, only the first code should
be reported. The HCPCS/CPT code ______ (the column one HCPCS/CPT code)
descriptor includes the service described by the descriptor of HCPCS/CPT code _____
(the column two HCPCS/CPT code). Thus, based upon the HCPCS/CPT code
descriptors, HCPCS/CPT code ______ (the column two HCPCS/CPT code) is bundled
into HCPCS/CPT code ______ (the column one HCPCS/CPT code).
3. CPT Manual or CMS manual coding instruction: In addition to CPT
procedure code definitions or descriptors, instructions in the CPT Manual are provided
either as an introduction to CPT sections or parenthetically. Additionally CMS issues
coding instructions and guidelines in its manuals, program memoranda, and other
publications. In the case of HCPCS/CPT code____ (the column one HCPCS/CPT
code) and HCPCS/CPT code_____ (the column two HCPCS/CPT code), CPT or CMS
instructions identify appropriate methodology for code submission and accordingly,
HCPCS/CPT code ______ (the column two HCPCS/CPT code) is included in or cannot
be reported with HCPCS/CPT code _____ (the column one HCPCS/CPT code).

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4. Mutually exclusive procedures: In order to provide a sufficiently broad
listing of descriptive terms and identifying HCPCS/CPT codes, certain services or
procedures are listed which would not reasonably be performed at the same session by
the same provider on the same beneficiary. In the case of HCPCS/CPT
code______(the column one HCPCS/CPT code) and HCPCS/CPT code _____(the
column two HCPCS/CPT code), it would be unreasonable to expect these services to
be performed at a single patient encounter and, therefore, these HCPCS/CPT codes
have been paired together as edits.
5. Sequential procedure: If a provider attempts several procedures in direct
succession at a patient encounter to accomplish the same end, only the procedure that
successfully accomplishes the expected result is reported. Generally, this occurs when
a less extensive procedure fails and requires the performance of a more extensive
procedure. A failed procedure followed by a more extensive procedure should not be
reported separately. Procedures that are often performed in sequence have been
identified and the less extensive procedure is not separately reportable with the more
extensive procedure. When the procedures corresponding to HCPCS/CPT code____
(the column one HCPCS/CPT code) and HCPCS/CPT code _____ (the column two
HCPCS/CPT code) are performed in sequence at the same patient encounter, only
HCPCS/CPT code______ (the column one HCPCS/CPT code) may be reported.
6. CPT “Separate procedure” definition: The narrative for many HCPCS/CPT
codes includes a parenthetical statement that the procedure represents a "separate
procedure". The inclusion of this statement indicates that the procedure can be
performed separately but should not be reported when a related service is performed.
A “separate procedure” should not be reported when performed along with another
procedure in an anatomically related region through the same skin incision or orifice, or
surgical approach. HCPCS/CPT code____ (the column two HCPCS/CPT code) is
designated as a "separate procedure". Therefore, if it is reported with HCPCS/CPT
code______ (the column one HCPCS/CPT code), HCPCS/CPT code
(the column
two HCPCS/CPT code) is bundled into HCPCS/CPT code_____ (the column one
HCPCS/CPT code).
7. More extensive procedure: Some procedures can be performed at varying
levels of complexity. The HCPCS/CPT codes corresponding to more extensive
procedures always include the HCPCS/CPT codes corresponding to less complex
procedures. HCPCS/CPT code _______ (the column one HCPCS/CPT code) is a more
extensive procedure that includes HCPCS/CPT code_______ (the column two
HCPCS/CPT code). Accordingly, only the more extensive procedure, HCPCS/CPT
code ______ (the column one HCPCS/CPT code) should be reported. HCPCS/CPT
code_____ (the column two HCPCS/CPT code) is bundled into HCPCS/CPT
code______ (the column one HCPCS/CPT code).

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8. Reserved for Future Use
9. Gender-specific procedures: The performance of certain procedures may
require significantly different approaches when performed in a male as opposed to a
female. Some HCPCS/CPT code descriptors designate these procedures by specifying
if the service or procedure is to be reported for a male or a female or by anatomical
description. HCPCS/CPT code combinations that are identical, except that one code
describes a procedure for a female and the other describes a procedure for a male,
cannot be reported for the same session, the same provider, and the same beneficiary.
HCPCS/CPT codes _____ (the column one HCPCS/CPT code) and HCPCS/CPT
code_____(the column two HCPCS/CPT code) represent such a combination and
should not be reported together.
10. Standards of medical/surgical practice: Under Medicare, all services
necessary to complete a procedure based upon standard medical/surgical practice are
included in the procedure. Many procedures that are typically necessary to complete a
more comprehensive procedure have been assigned independent HCPCS/CPT codes
because they may be performed independently in other settings. The service described
by HCPCS/CPT code ____ (the column two HCPCS/CPT code) is typically included
when performing the procedure described by HCPCS/CPT code ____ (the column one
HCPCS/CPT code) and is therefore bundled into HCPCS/CPT code _____(the column
one HCPCS/CPT code.)
11. Anesthesia service included in surgical procedure: Pursuant to
Medicare’s Anesthesiology Rules, Medicare does not pay separately for anesthesia
other than moderate conscious sedation under certain circumstances when provided by
the same physician who performs the medical or surgical procedure requiring the
anesthesia. HCPCS/CPT codes describing anesthesia services or services that are
bundled into anesthesia services should not be reported in addition to the surgical
procedure requiring the anesthesia services. Accordingly, HCPCS/CPT code ____ (the
column two HCPCS/CPT code representing the anesthesia service or service bundled
into anesthesia) is included in the surgical service described by HCPCS/CPT code____
(the column HCPCS/CPT code).
12. Laboratory panel: Laboratory panels, described in CPT as "Organ or
Disease Oriented Panels,” define groupings of laboratory tests that are commonly
performed together in clinical practice. When a HCPCS/CPT code describing a panel is
reported, HCPCS/CPT codes identifying the individual tests included in the panel should
not be reported separately. HCPCS/CPT code____ (the column one HCPCS/CPT code
representing the laboratory panel) includes HCPCS/CPT code _____ (the column two
HCPCS/CPT code). Therefore HCPCS/CPT code____ (the column two HCPCS/CPT
code) is bundled into HCPCS/CPT code____ (the laboratory panel code or the column
one HCPCS/CPT code.)
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13. Deleted/modified edits for NCCI: National Correct Coding Initiative (NCCI)
edits were developed based upon review of existing local and national edits, review of
standards of medical care, review of CPT instructions and descriptors, review of
provider billing patterns and Medicare policies. Comments about NCCI PTP edits are
received from the AMA and the national medical societies, representatives of the AMA’s
CPT Editorial Panel, CPT Advisory, and Health Care Professionals Advisory (HCPAC)
Committees, CMS Central and Regional Offices, Contractor Medical Directors,
contractor staff, physicians, other providers, and independent billing consultants. Based
upon input from these sources, NCCI PTP edits are sometimes deleted. NCCI PTP
edits may also be deleted for other reasons such as CMS policies, modified
HCPCS/CPT code descriptors or coding instructions, deletion of HCPCS/CPT codes, or
modified medical practice. (Occasionally the order of the codes in an edit needs to be
reversed. In such situations, the original edit is deleted and a new edit is added with the
order of the codes reversed.) The HCPCS/CPT code pair edit, HCPCS/CPT code
______ (the column one HCPCS/CPT code) and HCPCS/CPT code ______ (the
column two HCPCS/CPT code) was deleted from the NCCI for one of these reasons.
14. Misuse of column two code with column one code: HCPCS/CPT codes
have been written as precisely as possible to not only describe a specific procedure but
to also avoid describing similar procedures which are already defined by other
HCPCS/CPT codes. When a HCPCS/CPT code is reported, the physician or nonphysician provider must have performed all of the services noted in the descriptor
unless the descriptor states otherwise. (Occasionally, a HCPCS/CPT code descriptor
will identify certain services that may or may not be included.) A HCPCS/CPT code
should not be reported out of the context for which it was intended. When the
procedure described by HCPCS/CPT code _________ (the column two HCPCS/CPT
code) is reported with the procedure described by HCPCS/CPT code _______ (the
column one HCPCS/CPT code), reporting the former code represents a misuse of this
code, and separate payment is not allowed.
15. Medically Unlikely Edits (MUE) (Units of Service): Most HCPCS/CPT
codes describe procedures that may be reported a maximum number of times by a
single provider for the same beneficiary on the same date of service. If a provider bills
units of service for HCPCS/CPT codes in excess of established limits, the edits prevent
payment. The Medically Unlikely Edit values are set based upon anatomic
considerations, HCPCS/CPT code descriptors, HCPCS/CPT coding instructions, CMS
policies, nature of analyte, nature of service/procedure, nature of equipment, and/or
clinical judgment based on input from many sources. MUE values were reviewed by
national healthcare organizations before implementation. All MUE values have been
evaluated with 100% claims data from a six month period. CMS publishes most MUE
values. However, unpublished MUE values are confidential information for CMS and
CMS contractors’ use only. No information about unpublished MUE values shall be
released or shared outside your organization.
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16. Deleted/modified edits for MUE: Medically Unlikely Edits (MUE) were
developed based upon anatomic considerations, HCPCS/CPT code descriptors,
HCPCS/CPT coding instructions, CMS policies, nature of service/procedure, nature of
analyte, nature of equipment, and/or clinical judgment. Prior to implementation most
MUE were reviewed by national healthcare organizations. Comments about MUE are
received from the AMA and the national medical societies, representatives of the AMA’s
CPT Editorial Panel, CPT Advisory, and Health Care Professionals Advisory (HCPAC)
Committees, CMS Central and Regional Offices, Medicare Contractor Medical
Directors, contractor staff, physicians, other providers, and independent billing
consultants. Based upon input from these sources, an MUE may be deleted. MUE may
also be deleted for other reasons such as CMS policies, modified HCPCS/CPT code
descriptors or coding instructions, deletion of HCPCS/CPT codes, or modified medical
practice. (Occasionally an MUE is modified. In such situations the original MUE is
deleted, and a new MUE with the revised MUE value is added). The MUE for the
HCPCS/CPT code ______ was deleted or modified for one of these reasons.

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National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
Anesthesia Services
CPT Codes 00000-09999
Correspondence Language Policy/Example Number 1.00000 - Standard
preparation/monitoring services for anesthesia
An example of a “standard preparation/monitoring service” integral to anesthesia
services is the placement of an intravenous access line (CPT code 36000) prior to the
administration of general anesthesia. This procedure is necessary to prepare the
patient for a general anesthesia procedure and, therefore, is included as a part of the
anesthesia service. CPT code 36000 is bundled into all anesthesia service codes.
Correspondence Language Policy/Example Number 2.00000 – HCPCS/CPT
procedure code definition
For example, the descriptor for CPT code 99143 “(Moderate sedation services (other
than those services described by codes 00100-01999) provided by the same physician
performing the diagnostic or therapeutic service that the sedation supports, requiring the
presence of an independent trained observer to assist in the monitoring of the patient's
level of consciousness and physiological status; younger than 5 years of age, first 30
minutes intra-service time)” indicates that the code includes moderate conscious
sedation services other than those services described by anesthesia codes (0010001999). Therefore, CPT code 99143 should not be separately reported with anesthesia
codes such as CPT code 00100 “(Anesthesia for procedures on salivary glands,
including biopsy)”.
Correspondence Language Policy/Example Number 3.00000 - CPT Manual or CMS
manual coding instruction
For example, in the CPT Manual instruction under anesthesia for diagnostic
arteriography/venography (CPT code 01916), the reference note states: “(Do not report
01916 in conjunction with therapeutic codes 01924-01926, 01930-01933)”. Therefore,
CPT code 01916 is bundled with CPT codes 01924-01926 and 01930-01933.

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Correspondence Language Policy/Example Number 7.00000 – More extensive
procedure
For example, CPT code 01830 describes anesthesia for open or surgical
arthroscopic/endoscopic procedures on the wrist as well as other sites contiguous to the
wrist, and CPT code 01829 describes anesthesia for diagnostic arthroscopic procedures
on the wrist. Reporting CPT code 01829 with CPT code 01830 is not appropriate
because the procedure described by CPT code 01830 is more extensive than the
procedure described by CPT code 01829. In this case CPT code 01829 is bundled into
CPT code 01830.
Correspondence Language Policy/Example Number 14.00000 - Misuse of column
two code with column one code
For example, CPT code 95956 describes “Monitoring for localization of cerebral seizure
focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG)
recording and interpretation, each 24 hours”. When EEG monitoring is performed
during anesthesia for an intracranial procedure (CPT code 00210), reporting this
monitoring separately with CPT code 95956 is a misuse of CPT code 95956.
Intraoperative EEG monitoring is integral to anesthesia services for intracranial
procedures. Therefore CPT code 95956 is not reported separately with CPT code
00210.
Correspondence Language Policy/Example Number 15.00000 – Medically Unlikely
Edits (Units of Service)
For example, CPT code 01996 (“Daily hospital management of epidural or
subarachnoid continuous drug administration”) by definition includes management of
epidural or subarachnoid continuous drug administration for an entire day. This code
may be reported with only one unit of service for a single date of services. If units of
service in excess of one are reported, the MUE prevents payment.
Medically Unlikely Edits (Units of Service) do not apply to Anesthesia Services
(CPT codes 00100-01995).

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National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
Integumentary System
CPT Codes 10000-19999
Correspondence Language Policy/Example Number 2.10000 – HCPCS/CPT
procedure code definition
For example, the code descriptor for CPT code 19302 is “Mastectomy, partial (eg,
lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary
lymphadenectomy”, and the code descriptor for CPT code 19301 is “Mastectomy, partial
(eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);”. Therefore, based
upon the code descriptors the procedure described by CPT code 19301 is a component
of the procedure described by CPT code 19302, and CPT code 19301 is bundled into
CPT code 19302.
Correspondence Language Policy/Example Number 3.10000 - CPT Manual or CMS
manual coding instruction
For example, the CPT Manual instruction under “Excision - Benign Lesions”, states that
the excision includes simple closure. Therefore the procedure described by the column
one CPT code 11400 (“Excision, benign lesion including margins, except skin tag
(unless listed elsewhere), trunk, arms, or legs; excised diameter 0.5 cm or less”)
includes the procedure described by the column two CPT code 12001 (“Simple repair of
superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities
(including hands and feet); 2.5cm or less”). CPT code 12001 is bundled into CPT code
11400.
Correspondence Language Policy/Example Number 4.10000 - Mutually exclusive
procedures
For example, a physician performing a destruction of a malignant lesion of the arm by
laser surgery, electrosurgery, cryosurgery, chemosurgery, or surgical curettement (CPT
code 17260) would not also report an excision of the same malignant lesion of the arm
(CPT code 11600). Only one method of treatment of the malignant skin lesion would be
performed at a single patient encounter. Therefore, CPT codes 17260 and 11600 are
mutually exclusive of each other.

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Correspondence Language Policy/Example Number 5.10000 - Sequential
procedure
For example, CPT code 10021 describes a fine needle aspiration biopsy without
imaging guidance. CPT code 19101 describes an open incisional biopsy of the breast.
If a fine needle aspiration biopsy of a breast lesion is unsuccessful and the physician
sequentially performs an incisional biopsy of the same lesion at the same patient
encounter, only the successful open incisional biopsy may be reported. Therefore, CPT
code 10021 is not separately reportable with CPT code 19101.
Correspondence Language Policy/Example Number 6.10000 – CPT “separate
procedure” definition
For example, the code descriptor for CPT code 19100 (“Biopsy of breast; percutaneous,
needle core, not using imaging guidance (separate procedure)”) includes the “separate
procedure” designation. When an excision of a breast lesion (CPT code 19125) is
performed, the procedure described by CPT code 19100 does not meet the definition of
a “separate procedure” when performed on the same breast. Therefore, CPT code
19100 cannot be reported separately and is bundled into CPT code 19125 when both
services are performed on the same breast.
Correspondence Language Policy/Example Number 7.10000 - More extensive
procedure
For example, CPT code 19307 describes a modified radical mastectomy which removes
the entire breast and axillary adipose tissue. Although the primary purpose of a radical
mastectomy is generally the treatment of a malignant lesion, other lesions in the breast
such as cysts are also removed. Separate reporting of CPT code 19120 which
describes excision of benign breast lesions such as cysts is not appropriate with CPT
code 19307 for the same breast because the latter represents the more extensive
procedure. In this example CPT code 19120 is bundled into CPT code 19307.
Correspondence Language Policy/Example Number 10.10000 - Standards of
medical/surgical practice
For example, blepharoplasty of the upper eyelid (CPT code 15822) includes repair of
the incision (CPT code 12011) as a standard of medical/surgical practice. Therefore,
CPT code 12011 is bundled into CPT code 15822.

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Correspondence Language Policy/Example Number 11.10000 - Anesthesia
service included in surgical procedure
For example, when an avulsion of a nail plate (CPT code 11730) is performed,
anesthesia may be provided by the surgeon using a digital nerve block (CPT code
64450). Because this type of anesthesia provided by the surgeon performing the
procedure is not separately payable, CPT code 64450 is bundled into CPT code 11730
when the same physician performs both procedures.
Correspondence Language Policy/Example Number 14.10000 - Misuse of column
two code with column one code
For example, CPT code 11900 (Intralesional injection) describes a therapeutic
cutaneous intralesional injection. It is a misuse of this code to report it for the injection
of local anesthesia in order to perform another procedure such as an excision of a
benign skin lesion (CPT code 11400). Therefore, CPT code 11900 is bundled into CPT
code 11400.
Correspondence Language Policy/Example Number 15.10000 – Medically Unlikely
Edits (Units of Service)
For example, CPT code 11719 (Trimming of nondystrophic nails, any number) by
definition includes “any number” of nails. This code may be reported only once for a
patient on any single date of service by the same provider. If units of service in excess
of one are reported, the MUE prevents payment.

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National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
Musculoskeletal System
CPT Codes 20000-29999
Correspondence Language Policy/Example Number 2.20000 - HCPCS/CPT
procedure code definition
For example, the code descriptor for CPT code 21045 is “Excision of malignant tumor of
mandible; radical resection”, and the code descriptor for CPT code 21044 is “Excision of
malignant tumor of mandible;”. Therefore based upon the code descriptors the
procedure described by CPT code 21044 is a component of the procedure described by
CPT code 21045, and CPT code 21044 is bundled into CPT code 21045.
Correspondence Language Policy/Example Number 3.20000 - CPT Manual or CMS
manual coding instruction
For example, the parenthetical note following CPT code 29889 states: “(Procedures
29888 and 29889 should not be used with reconstruction procedures 27427-27429)”.
Thus, CPT codes 29888 and 29889 are bundled into the more comprehensive
procedures reported as CPT codes 27427, 27428, and 27429.
Correspondence Language Policy/Example Number 4.20000 - Mutually exclusive
procedures
For example, CPT codes 27441 and 27442 describe different types of knee
arthroplasties of the tibial plateau. CPT code 27441 describes the procedure on the
tibial plateau with debridement and partial synovectomy and CPT code 27442 describes
the procedure on femoral condyles or the tibial plateau(s). Since both procedures
would not be performed on the same knee at the same patient encounter, the two
procedures are mutually exclusive of one another.
Correspondence Language Policy/Example Number 5.20000 - Sequential
procedure
For example, if an initial deep bone biopsy by needle or trocar (CPT code 20225) is
unsuccessful and is followed by an open biopsy (CPT code 20250) at the same patient
encounter, only CPT code 20250 may be reported. Therefore, CPT code 20225 is not
separately reportable with CPT code 20250.

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Correspondence Language Policy/Example Number 6.20000 – CPT “separate
procedure” definition
For example, the code descriptor for CPT code 29870 (“Arthroscopy, knee, diagnostic,
with or without synovial biopsy (separate procedure)”) includes the “separate procedure”
designation. When a diagnostic arthroscopy of the knee with major synovectomy in two
or more compartments (CPT code 29876) is performed, the procedure described by
CPT code 29870 on the same knee does not meet the definition of a “separate
procedure”. Therefore, CPT code 29870 cannot be reported separately and is bundled
into CPT code 29876 when both services are performed on the same knee.
Correspondence Language Policy/Example Number 7.20000 - More extensive
procedure
For example, CPT code 21012 describes excision of a subcutaneous soft tissue tumor
of the face or scalp that measures 2 cm or more. CPT code 21011 describes excision
of a subcutaneous soft tissue tumor of the face or scalp that measures less than 2 cm.
Since excision of a tumor greater than 2 cm or more (CPT code 21012) is more
extensive than excision of a tumor less than 2 cm (CPT code 21011) when performed at
the same anatomic site, CPT code 21011 is bundled into CPT code 21012.
Correspondence Language Policy/Example Number 10.20000 - Standards of
medical/surgical practice
For example, CPT code 25115 describes a radical excision of a bursa or synovia of the
wrist. It is standard surgical practice to preserve neurologic function by isolating and
freeing nerves as necessary. A neuroplasty (e.g. CPT code 64719) should not be
reported separately for this process. Therefore, CPT code 64719 is bundled into CPT
code 25115.
Correspondence Language Policy/Example Number 11.20000 - Anesthesia
service included in surgical procedure
For example, when a small joint or bursa arthrocentesis, aspiration and/or injection
(CPT code 20600) is performed, anesthesia may be provided by the surgeon using a
digital nerve block (CPT code 64450). Because this type of anesthesia provided by the
surgeon performing the procedure is not separately payable, CPT code 64450 is
bundled into CPT code 20600 when the same physician performs both procedures.

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Correspondence Language Policy/Example Number 14.20000 - Misuse of column
two code with column one code
For example, CPT code 20550 (“Injection(s); single tendon sheath, or ligament,
aponeurosis (eg, plantar “fascia”)”) describes a therapeutic musculoskeletal injection. It
is a misuse of this code to report it for the injection of local anesthesia in order to
perform another procedure such as a hallux valgus correction (CPT code 28292).
Therefore, CPT code 20550 is bundled into CPT code 28292.
Correspondence Language Policy/Example Number 15.20000 – Medically Unlikely
Edits (Units of Service)
For example, CPT code 27440 (Arthroplasty, knee, tibial plateau) may only be
performed on a knee once on a single date of service. If performed on a single knee,
this procedure would be reported with one unit of service. If this procedure is performed
bilaterally, it should be reported with modifier 50 and one unit of service. If units of
service in excess of one are reported, the MUE prevents payment.

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National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
Respiratory System, Cardiovascular System,
Hemic and Lymphatic Systems, Mediastinum and Diaphragm
CPT Codes 30000-39999
Correspondence Language Policy/Example Number 2.30000 - HCPCS/CPT
procedure code definition
For example, the code descriptor for CPT code 33612 is “Repair of double outlet right
ventricle with intraventricular tunnel repair; with repair of right ventricular outflow tract
obstruction” and the code descriptor for CPT code 33611 is “Repair of double outlet
right ventricle with intraventricular tunnel repair;”. Therefore, based upon the code
descriptors the procedure described by CPT code 33611 is a component of the
procedure described by CPT code 33612, and CPT code 33611 is bundled into CPT
code 33612.
Correspondence Language Policy/Example Number 3.30000 - CPT Manual or CMS
manual coding instruction
For example, CPT code 33645 describes a direct or patch closure of the sinus venosus
with or without anomalous pulmonary venous drainage. The CPT Manual instruction
below CPT code 33645 states: “(Do not report 33645 in conjunction with 33724,
33726)”. Therefore, CPT code 33724 which describes a repair of isolated partial
anomalous pulmonary venous return may not be reported in addition to CPT code
33645.
Correspondence Language Policy/Example Number 4.30000 - Mutually exclusive
procedures
For example, CPT codes 33820 and 33822 describe different types of repairs of a
patent ductus arteriosus. CPT code 33820 describes a patent ductus arteriosus repair
by ligation, and CPT code 33822 describes a patent ductus arteriosus repair by division.
Since both procedures would not be performed on a patent ductus arteriosus at the
same patient encounter, the two procedures are mutually exclusive of one another.

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Correspondence Language Policy/Example Number 5.30000 - Sequential
procedure
For example, if a surgical endoscopic operative tissue ablation and reconstruction of
atria, limited (eg, modified maze procedure), without cardiopulmonary bypass (CPT
code 33265) is unsuccessful and is followed at the same patient encounter by an open
operative tissue ablation and reconstruction of atria, limited (eg, modified maze
procedure) (CPT code 33254), only CPT code 33254 may be reported. Therefore, CPT
code 33265 is not separately reportable with CPT code 33254.
Correspondence Language Policy/Example Number 6.30000 – CPT “separate
procedure” definition
For example, the code descriptor for CPT code 33210 (“Insertion or replacement of
temporary transvenous single chamber cardiac electrode or pacemaker catheter
(separate procedure)”) includes the “separate procedure” designation. When a
coronary artery bypass with single arterial graft procedure (CPT code 33533) is
performed, the procedure described by CPT code 33210 does not meet the definition of
a “separate procedure”. Therefore, CPT code 33210 cannot be reported separately and
is bundled into CPT code 33533.
Correspondence Language Policy/Example Number 7.30000 - More extensive
procedure
For example, CPT code 32663 describes thoracoscopy with lobectomy of a single lobe.
CPT code 32671 describes thoracoscopy with removal of the entire lung
(pneumonectomy). Since the right lung has three lobes and the left lung has two lobes,
a pneumonectomy (CPT code 32671) is a more extensive procedure than a lobectomy
(CPT code 32663). Therefore, CPT code 32663 is bundled into CPT code 32671.
Correspondence Language Policy/Example Number 10.30000 - Standards of
medical/surgical practice
For example, CPT code 32480 describes the removal of a single lobe of a lung. CPT
code 32100 describes a thoracotomy with exploration which is the surgical approach for
the procedure described by CPT code 32480 and is the standard of medical/surgical
practice. Therefore, CPT code 32100 is bundled into CPT code 32480.

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Correspondence Language Policy/Example Number 11.30000 - Anesthesia
service included in surgical procedure
For example, when direct operative laryngoscopy with foreign body removal is
performed (CPT code 31530) and anesthesia is also performed by the surgeon (CPT
code 00320), separate reporting for the anesthesia service is inappropriate. Therefore
CPT code 00320 is bundled into CPT code 31530.
Correspondence Language Policy/Example Number 14.30000 - Misuse of column
two code with column one code
For example, CPT code 35226 (“Repair blood vessel, direct; lower extremity”) describes
an open blood vessel repair of the lower extremity. It is a misuse of CPT code 35226 to
report it for the repair of the site where a percutaneous intra-aortic balloon assist device
is removed (CPT code 33968). Therefore CPT code 35226 is bundled into CPT code
33968.
Correspondence Language Policy/Example Number 15.30000 – Medically Unlikely
Edits (Units of Service)
For example, CPT code 33470 (Valvotomy, pulmonary valve, closed heart;
transventricular) may be reported with a maximum of one unit of service on a single
date of service since the heart has one pulmonary valve. If units of service in excess of
one are reported, the MUE prevents payment.

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National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
Digestive System
CPT Codes 40000-49999
Correspondence Language Policy/Example Number 2.40000 - HCPCS/CPT
procedure code definition
For example, the code descriptor for CPT code 45805 is “Closure of rectovesical fistula;
with colostomy” and the code descriptor for CPT code 45800 is “Closure of rectovesical
fistula;”. Therefore, based upon the code descriptors the procedure described by CPT
code 45800 is a component of the procedure described by CPT code 45805, and CPT
code 45800 is bundled into CPT code 45805.
Correspondence Language Policy/Example Number 3.40000 - CPT Manual or CMS
manual coding instruction
For example, the CPT Manual instruction above CPT code 49491 states: “With the
exception of the incisional hernia repairs (see 49560-49566) the use of mesh or other
prostheses is not separately reported.” Therefore, CPT code 49568 (mesh
implantation) should not be reported separately with CPT code 49505 (inguinal hernia
repair).
Correspondence Language Policy/Example Number 4.40000 - Mutually exclusive
procedures
For example, CPT codes 43100 and 43101 describe different approaches to the
excision of an esophageal lesion. CPT code 43100 describes a cervical approach, and
CPT code 43101 describes a thoracic or abdominal approach. Since both procedures
would not be performed at the same patient encounter, the two procedures are mutually
exclusive of one another.
Correspondence Language Policy/Example Number 5.40000 - Sequential
procedure
For example, if an anoscopy with control of bleeding (CPT code 46614) is unsuccessful
and is followed by a complex or an extensive internal and external hemorrhoidectomy
(CPT code 46260), only CPT code 46260 may be reported. Therefore, CPT code
46614 is not separately reportable with CPT code 46260.

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Correspondence Language Policy/Example Number 6.40000 – CPT “separate
procedure” definition
For example, the code descriptor for CPT code 44005 (“Enterolysis (freeing of intestinal
adhesion) (separate procedure)”) includes the “separate procedure” designation. When
a partial colectomy with anastomosis (CPT code 44140) is performed, the procedure
described by CPT code 44005 does not meet the definition of a “separate procedure”.
Therefore, CPT code 44005 cannot be reported separately and is bundled into CPT
code 44140.
Correspondence Language Policy/Example Number 7.40000 - More extensive
procedure
For example, CPT code 42426 describes excision of a parotid gland tumor with radical
neck dissection. CPT code 42425 describes excision of a parotid gland tumor without a
radical neck dissection. The procedure described by CPT code 42426 is more
extensive than the procedure described by CPT code 42425. Therefore, CPT code
42425 is bundled into CPT code 42426.
Correspondence Language Policy/Example Number 10.40000 - Standards of
medical/surgical practice
For example, during a tonsillectomy (CPT code 42821) bleeding may occur. The
control of such bleeding intraoperatively is a standard of surgical practice. It is
inappropriate to report separately CPT code 42961 (control of oropharyngeal
hemorrhage). Therefore, CPT code 42961 is bundled into CPT code 42821.
Correspondence Language Policy/Example Number 11.40000 - Anesthesia
service included in surgical procedure
For example, if an ilioinguinal or iliohypogastric nerve block (CPT code 64425) is
performed for anesthesia by the physician performing an inguinal hernia repair (CPT
code 49505), the nerve block is included in the surgical procedure and is not reported
separately. Therefore, CPT code 64425 is bundled into CPT code 49505.

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Correspondence Language Policy/Example Number 14.40000 - Misuse of column
two code with column one code
For example, CPT code 44378 describes small intestinal endoscopy with control of
bleeding. CPT code 44361 describes small intestinal endoscopy with biopsy. It is a
misuse of CPT code 44378 to report control of bleeding resulting from a small intestinal
biopsy. A small intestinal biopsy is often accompanied by a small amount of bleeding,
the control of which is inherent to the procedure and is not separately reportable.
Therefore, CPT code 44378 is bundled into CPT code 44361. CPT code 44378 should
not be reported separately unless it is performed as a distinct procedure unrelated to
bleeding due to the biopsy.
Correspondence Language Policy/Example Number 15.40000 – Medically Unlikely
Edits (Units of Service)
For example, CPT code 44950 (Appendectomy) may be reported with a maximum of
one unit of service since there is only one appendix. If units of service in excess of one
are reported, the MUE prevents payment.

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National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
Urinary System, Male Genital System, Intersex Surgery,
Female Genital System, Maternity Care and Delivery
CPT Codes 50000-59999
Correspondence Language Policy/Example Number 2.50000 - HCPCS/CPT
procedure code definition
For example, the code descriptor for CPT code 51925 is “Closure of vesicouterine
fistula; with hysterectomy”, and the code descriptor for CPT code 51920 is “Closure of
vesicouterine fistula;”. Therefore, based upon the code descriptors the procedure
described by CPT code 51920 is a component of the procedure described by CPT code
51925, and CPT code 51920 is bundled into CPT code 51925.
Correspondence Language Policy/Example Number 3.50000 - CPT Manual or CMS
manual coding instruction
For example, the parenthetical note following CPT code 58146 states: “(Do not report
58146 in addition to 58140-58145, 58150-58240)”. Therefore, CPT code 58146 is not
separately reportable with CPT code 58150.
Correspondence Language Policy/Example Number 4.50000 - Mutually exclusive
procedures
For example, CPT codes 50800 and 50860 describe different types of ureteral diversion
procedures. CPT code 50800 describes diversion to the intestine, and CPT code 50860
describes diversion to the skin (ureterostomy). Since both procedures would not be
performed on the same ureter at the same patient encounter, the two procedures are
mutually exclusive of one another.
Correspondence Language Policy/Example Number 5.50000 - Sequential
procedure
For example, if a needle or punch biopsy of the prostate by any approach (CPT code
55700) is unsuccessful and is followed at the same patient encounter by an incisional
biopsy of the prostate (CPT code 55705), only CPT code 55705 may be reported.
Therefore, CPT code 55700 is bundled into CPT code 55705.

Correspondence Language Policy/Example Number 6.50000 – CPT “separate
procedure” definition
For example, the code descriptor for CPT code 49000 (“Exploratory laparotomy,
exploratory celiotomy with or without biopsy(s) (separate procedure)”) includes the
“separate procedure” designation. When a total abdominal hysterectomy, with or
without removal of tubes and/or ovaries (CPT code 58150) is performed, the procedure
described by CPT code 49000 does not meet the definition of a “separate procedure”.
Therefore, CPT code 49000 cannot be reported separately and is bundled into CPT
code 58150.
Correspondence Language Policy/Example Number 7.50000 - More extensive
procedure
For example, CPT code 54530 describes a radical orchiectomy through an inguinal
approach. Since a partial orchiectomy (CPT code 54522) removes a smaller portion of
the testis, the procedure described by CPT code 54530 is more extensive than the one
described by CPT code 54522. Therefore, CPT code 54522 is bundled into CPT code
54530.
Correspondence Language Policy/Example Number 9.50000 - Gender-specific
procedures
For example, CPT code 52270 describes a cystourethroscopy with an internal
urethrotomy for a female, and CPT code 52275 describes the identical procedure for a
male. The two procedures cannot be reported for the same beneficiary. Therefore only
the appropriate code should be reported.
Correspondence Language Policy/Example Number 10.50000 - Standards of
medical/surgical practice
For example, CPT code 51820 describes a cystourethroplasty with unilateral or bilateral
ureteroneocystostomy. CPT code 51701 describes an insertion of a non-dwelling
bladder catheter and may be performed as a standard of medical/surgical practice prior
to performing a cystourethroplasty with ureteroneocystostomy (CPT code 51820).
Therefore, CPT code 51701 is bundled into CPT code 51820.
Correspondence Language Policy/Example Number 11.50000 - Anesthesia
service included in surgical procedure
For example, when an incision and drainage of a Bartholin’s gland abscess (CPT code
56420) is performed and anesthesia is also performed by the surgeon (CPT code
00940), separate reporting for the anesthesia service is inappropriate. Therefore, CPT
code 00940 (anesthesia for vaginal procedures) is bundled into CPT code 56420.
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Correspondence Language Policy/Example Number 14.50000 - Misuse of column
two code with column one code
For example, an incidental appendectomy during another intra-abdominal surgical
procedure should not be reported separately. It is a misuse of CPT code 44950
(“Appendectomy”) to report it for an incidental appendectomy during the procedure
described by CPT code 58150 (Total abdominal hysterectomy, with or without removal
of tube(s), with or without removal of ovary(s)). Therefore, CPT code 44950 is bundled
into CPT code 58150.
Correspondence Language Policy/Example Number 15.50000 – Medically Unlikely
Edits (Units of Service)
For example, CPT code 55840 (Prostatectomy, retropubic radical, with or without nerve
sparing) may be reported with a maximum of one unit of service because there is only
one prostate gland in males. If units of service in excess of one are reported, the MUE
prevents payment.

National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
Endocrine System, Nervous System, Eye and Ocular Adnexa,
Auditory System, Operating Microscope
CPT Codes 60000-69999
Correspondence Language Policy/Example Number 2.60000 - HCPCS/CPT
procedure code definition
For example, the code descriptor for CPT code 67039 is “Vitrectomy, mechanical, pars
plana approach; with focal endolaser photocoagulation” and the code descriptor for CPT
code 67036 is “Vitrectomy, mechanical, pars plana approach;”. Therefore, based upon
the code descriptors the procedure described by CPT code 67036 is a component of
the procedure described by CPT code 67039, and CPT code 67036 is bundled into CPT
code 67039.
Correspondence Language Policy/Example Number 3.60000 - CPT Manual or CMS
manual coding instruction
For example, CPT code 66711 describes a ciliary body destruction with endoscopic
cyclophotocoagulation. The CPT Manual instruction following CPT code 66711 states:
“(Do not report 66711 in conjunction with 66990)”. Therefore, CPT code 66990 for use
of ophthalmic endoscope is bundled into CPT code 66711.
Correspondence Language Policy/Example Number 4.60000 - Mutually exclusive
procedures
For example, CPT codes 69433 and 69436 describe different types of tympanostomy
requiring insertion of ventilating tube. CPT code 69433 describes the procedure
performed with local or topical anesthesia, and CPT code 69436 describes the
procedure performed with general anesthesia. Since both procedures would not be
performed at the same patient encounter, the two procedures are mutually exclusive of
one another.
Correspondence Language Policy/Example Number 5.60000 - Sequential
procedure
For example, if a fine needle aspiration of the thyroid (CPT code 10021) is unsuccessful
and is followed at the same patient encounter by a percutaneous core needle biopsy of
the thyroid (CPT code 60100), only CPT code 60100 may be reported. Therefore, CPT
code 10021 is not separately reportable with CPT code 60100.
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Correspondence Language Policy/Example Number 6.60000 – CPT “separate
procedure” definition
For example, the code descriptor for CPT code 65860 (“Severing adhesions of anterior
segment, laser technique (separate procedure)”) includes the “separate procedure”
designation. When a trabeculoplasty by laser surgery (CPT code 65855) is performed,
the procedure described by CPT code 65860 does not meet the definition of a “separate
procedure”. Therefore, CPT code 65860 cannot be reported separately and is bundled
into CPT code 65855.
Correspondence Language Policy/Example Number 7.60000 - More extensive
procedure
For example, CPT code 67228 describes destruction of extensive diabetic retinopathy
by photocoagulation. CPT code 67208 describes destruction of a localized retinal
lesion by cryotherapy. The procedure described by CPT code 67228 is more extensive
than the procedure described by CPT code 67208. Therefore, CPT code 67208 is
bundled into CPT code 67228.
Correspondence Language Policy/Example Number 10.60000 - Standards of
medical/surgical practice
For example, CPT code 60240 describes a total or complete thyroidectomy. CPT code
60500 describes a parathyroidectomy or exploration of parathyroid(s).
The exploration of parathyroid glands with or without parathyroidectomy (CPT code
60500) is standard surgical practice when performing a complete thyroidectomy (CPT
code 60240). Therefore, CPT code 60500 is bundled into CPT code 60240.
Correspondence Language Policy/Example Number 11.60000 - Anesthesia
service included in surgical procedure
For example, if the surgeon performing a cataract extraction (CPT code 66984) also
provides anesthesia (CPT code 00142), the anesthesia service is not reported
separately. Therefore, CPT code 00142 is bundled into CPT code 66984.
Correspondence Language Policy/Example Number 14.60000 - Misuse of column
two code with column one code
For example, CPT code 20550 (“Injection(s); single tendon sheath, or ligament,
aponeurosis (eg, plantar “fascia”)”) describes a therapeutic musculoskeletal injection. It
is a misuse of this code to report it for the injection of local anesthesia in order to
perform another procedure such as a carpal tunnel release (CPT code 64721).
Therefore, CPT code 20550 is bundled into CPT code 64721.
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Correspondence Language Policy/Example Number 15.60000 – Medically Unlikely
Edits (Units of Service)
For example, CPT code 62292 (Injection procedure for chemonucleolysis, including
discography, intervertebral disc, single or multiple levels, lumbar) by definition includes
treatment at “single or multiple levels” of the lumbar spine. If units of service in excess
of one are reported, the MUE prevents payment.

National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
Radiology Services
CPT Codes 70000-79999
Correspondence Language Policy/Example Number 2.70000 - HCPCS/CPT
procedure code definition
For example, the code descriptor for CPT code 71270 is “Computed tomography,
thorax; without contrast material, followed by contrast material(s) and further sections”
and the code descriptor for CPT code 71260 is “Computed tomography, thorax; with
contrast material(s)”. Therefore, based upon the code descriptors the procedure
described by CPT code 71260 is a component of the procedure described by CPT code
71270, and CPT code 71260 is bundled into CPT code 71270.
Correspondence Language Policy/Example Number 3.70000 - CPT Manual or CMS
manual coding instruction
For example, CPT code 70332 describes radiological supervision and interpretation of a
temporomandibular joint arthrogram. The CPT Manual instruction following CPT code
70332 states: “(Do not report 70332 in conjunction with 77002).” Therefore, CPT code
77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device)) is bundled into CPT code 70332.
Correspondence Language Policy/Example Number 4.70000 - Mutually exclusive
procedures
For example, CPT codes 74240 and 74245 describe radiologic examination of the
upper gastrointestinal tract. CPT code 74245 also includes radiologic examination of
the small intestine which CPT code 74240 does not. Since both procedures could not
be performed at the same patient encounter, the two procedures are mutually exclusive
of one another.

Correspondence Language Policy/Example Number 6.70000 – CPT “separate
procedure” definition
For example, the code descriptor for CPT code 76000 (“Fluoroscopy (separate
procedure), up to one hour physician time, other than 71023 or 71034 (eg, cardiac
fluoroscopy)”) includes the “separate procedure” designation. When radiological
supervision and interpretation (RS&I) for percutaneous transhepatic biliary drainage
with contrast monitoring (CPT code 75980) is performed, the procedure described by
CPT code 76000 does not meet the definition of a “separate procedure”. Therefore,
CPT code 76000 cannot be reported separately and is bundled into CPT code 75980.
Correspondence Language Policy/Example Number 7.70000 - More extensive
procedure
For example, CPT code 72240 describes radiologic supervision and interpretation
(RS&I) for cervical myelography. CPT code 72270 describes RS&I for myelography of
two or more spinal regions (i.e. cervical/thoracic region, lumbar/thoracic region,
lumbar/cervical region). If the myelography RS&I performed includes two or more
spinal regions, one of which is the cervical region, the procedure described by CPT
code 72270 is more extensive than the one described by CPT code 72240. Therefore,
CPT code 72240 is bundled into CPT code 72270.
Correspondence Language Policy/Example Number 10.70000 - Standards of
medical/surgical practice
For example, CPT code 74170 describes an abdominal CT scan requiring intravenous
administration of contrast. Since intravenous insertion of a catheter (CPT code 36000)
is a standard medical/surgical practice to infuse the contrast, CPT code 36000 is
bundled into CPT code 74170.
Correspondence Language Policy/Example Number 11.70000 - Anesthesia
service included in surgical procedure
For example, if the physician performing magnetic resonance imaging of the cervical
spinal canal without contrast material (CPT code 72141) also provides anesthesia for
the non-invasive imaging (CPT code 01922), the anesthesia service is not reported
separately. Therefore, CPT code 01922 is bundled into CPT code 72141.

Correspondence Language Policy/Example Number 14.70000 - Misuse of column
two code with column one code
For example, CPT code 75945 describes intravascular ultrasound of a non-coronary
vessel. CPT code 76998 describes intraoperative ultrasound guidance. It is a misuse
of CPT code 76998 to report it for intraoperative ultrasound guidance to perform
intravascular ultrasound of a non-coronary vessel. Therefore, CPT code 76998 is
bundled into CPT code 75945.
Correspondence Language Policy/Example Number 15.70000 – Medically Unlikely
Edits (Units of Service)
For example, CPT code 77080 (Dual-energy X-ray absorptiometry (DXA), bone density
study, 1 or more sites; axial skeleton . . .) may be reported with a maximum of one unit
of service because the code descriptor includes all axial skeletal sites and the test
would only be performed once on a single date of service. If units of service in excess of
one are reported, the MUE prevents payment.

National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
Pathology and Laboratory Services
CPT Codes 80000-89999
Correspondence Language Policy/Example Number 2.80000 - HCPCS/CPT
procedure code definition
For example, the code descriptor for CPT code 80192 is “Procainamide; with
metabolites (eg, n-acetyl procainamide)” and the code descriptor for CPT code 80190 is
“Procainamide; ”. Therefore, based upon the code descriptors the procedure described
by CPT code 80190 is a component of the procedure described by CPT code 80192,
and CPT code 80190 is bundled into CPT code 80192.
Correspondence Language Policy/Example Number 3.80000 - CPT Manual or CMS
manual coding instruction
For example, CPT codes 86920 and 86923 describe different types of blood
compatibility testing. The CPT Manual instruction following CPT code 86923 states:
“(Do not use 86923 in conjunction with 86920-86922 for same unit crossmatch)”.
Therefore, CPT code 86923 cannot be reported with CPT codes 86920, 86921 and/or
86922 for compatibility testing of the same unit of blood.
Correspondence Language Policy/Example Number 4.80000 - Mutually exclusive
procedures
For example, CPT codes 81000 and 81001 describe different ways of performing
urinalysis with microscopy. The procedure described by CPT code 81000 utilizes a
manual process with dip stick or tablet reagent, and the procedure described by CPT
code 81001 utilizes an automated process. Since both procedures would not be
performed on the same urine specimen at the same patient encounter, the two
procedures are mutually exclusive of one another.

Correspondence Language Policy/Example Number 7.80000 - More extensive
procedure
For example, CPT code 80500 describes a clinical pathology consultation and CPT
code 80502 describes a clinical pathology consultation with review of patient history and
medical records. The procedure described by CPT code 80502 is more extensive than
the procedure described by CPT code 80500 because it requires additional review of
patient history and medical records. Therefore, CPT code 80500 is bundled into CPT
code 80502.
Correspondence Language Policy/Example Number 10.80000 - Standards of
medical/surgical practice
For example, CPT code 82575 describes creatinine clearance, and CPT code 82565
describes blood creatinine. Since determination of creatinine clearance (CPT code
82575) requires measurement of the blood creatinine (CPT code 82565) in addition to
urine creatinine and 24-hour urine volume, the measurement of blood creatinine is
included in the creatinine clearance as a standard of medical/surgical practice.
Therefore, CPT code 82565 is bundled into CPT code 82575.
Correspondence Language Policy/Example Number 12.80000 - Laboratory panel
For example, CPT code 80076 describes a hepatic function panel which includes seven
specific laboratory tests. If all seven individual tests are performed at the same patient
encounter, the hepatic function panel (CPT code 80076) may be reported. If one or
more of the seven specific laboratory tests such as serum albumin (CPT code 82040) is
additionally reported, it represents duplicate reporting of the laboratory test. Therefore,
CPT code 82040 is bundled into CPT code 80076 when performed on the same
specimen.
Correspondence Language Policy/Example Number 14.80000 - Misuse of column
two code with column one code
For example, the professional component CPT code 88141 describes the physician
interpretation of a diagnostic cervical or vaginal cytopathology specimen and may be
reported with technical component CPT codes for diagnostic cervical or vaginal
cytopathology such as CPT codes 88142-88154, 88164-88167, and 88174-88175. CPT
code 88141 should not be reported with HCPCS codes for screening cervical or vaginal
cytopathology such as G0143. It is a misuse of CPT code 88141 to report a physician
interpretation of a screening cervical or vaginal cytopathology specimen reported as
HCPCS code G0143.

Correspondence Language Policy/Example Number 15.80000 – Medically Unlikely
Edits (Units of Service)
For example, CPT code 83036 describes a test for Hemoglobin A1C (glycosylated
hemoglobin). Since this analyte is a measure of blood glucose control over the prior
three months, it would be measured at most once on a single date of service. If units of
service in excess of one are reported, the MUE prevents payment.

National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
Medicine Services
CPT Code 90000-99999
Correspondence Language Policy/Example Number 2.90000 - HCPCS/CPT
procedure code definition
For example, the code descriptor for CPT code 96406 is “Chemotherapy administration;
intralesional, more than 7 lesions”, and the code descriptor for CPT code 96405 is
“Chemotherapy administration; intralesional, up to and including 7 lesions”. Based upon
the code descriptors the procedure described by CPT code 96405 cannot be reported
with CPT code 96406 since either more than 7 or 7 or fewer lesions are treated.
Therefore, CPT code 96405 is bundled into CPT code 96406.
Correspondence Language Policy/Example Number 3.90000 - CPT Manual or CMS
manual coding instruction
For example, the CPT Manual instruction above CPT code 96150 states: “Do
not report 96150-96155 in conjunction with 90785-90899 on the same date.”
Therefore, CPT codes 96150-96155 (Health and behavior assessment and intervention)
may not be reported separately with CPT code 90791 (Psychiatric diagnostic
evaluation) and CPT codes 96150-96155 are bundled into CPT codes 90785-90899.
Correspondence Language Policy/Example Number 4.90000 - Mutually exclusive
procedures
For example, CPT codes 95953 and 95956 describe different types of EEG monitoring
for localization of cerebral seizure focus. CPT code 95953 describes monitoring by
computerized portable electroencephalography (16 or more channel EEG), and CPT
code 95956 describes monitoring by cable or radio, 16 or more channel telemetry.
Since both methods of EEG monitoring would not be utilized in the same 24-hour
period, the two procedures are mutually exclusive of one another.

Correspondence Language Policy/Example Number 6.90000 – CPT “separate
procedure” definition
For example, the code descriptor for CPT code 95851 (range of motion measurements
and report (separate procedure); each extremity . . .) includes the "separate procedure"
designation. When a physical therapy evaluation (CPT code 97001) is performed, the
procedure described by CPT code 95851 does not meet the definition of a “separate
procedure”. Therefore, CPT code 95851 cannot be reported separately and is bundled
into CPT code 97001.
Correspondence Language Policy/Example Number 7.90000 - More extensive
procedure
For example, CPT code 93010 describes the physician interpretation of an
electrocardiogram (ECG). CPT code 93042 describes the physician interpretation of a
cardiac rhythm strip. Since the ECG interpretation described by CPT code 93010
includes an interpretation of cardiac rhythm abnormalities, the procedure described by
CPT code 93010 is more extensive than the procedure described by CPT code 93042.
Therefore, CPT code 93042 is bundled into CPT code 93010.
Correspondence Language Policy/Example Number 10.90000 - Standards of
medical/surgical practice
For example, fluorescein angiography (CPT code 92235) requires the intravenous
administration of fluorescein. Since intravenous insertion of a catheter (CPT code
36000) is a standard of medical/surgical practice to infuse the fluorescein, CPT code
36000 is bundled into CPT code 92235.
Correspondence Language Policy/Example Number 11.90000 - Anesthesia
service included in surgical procedure
For example, when an induction of arrhythmia by electrical pacing (CPT code 93618) is
performed, anesthesia may be provided by the physician performing the procedure as
described by CPT code 00410 (anesthesia for the electrical conversion of arrhythmias).
Because anesthesia provided by the physician performing the procedure is not
separately payable, CPT code 00410 is bundled into CPT code 93618 when the same
physician performs both procedures.

Correspondence Language Policy/Example Number 14.90000 - Misuse of column
two code with column one code
For example, CPT code 96912 describes photochemotherapy with psoralens and
ultraviolet A light (PUVA). CPT code 77401 describes delivery of superficial radiation
therapy. It is a misuse of CPT code 77401 to report it in addition to CPT code 96912
when PUVA therapy is administered. Therefore CPT code 77401 ((radiation treatment
delivery) is bundled into CPT code 96912 (photochemotherapy).
Correspondence Language Policy/Example Number 15.90000 – Medically Unlikely
Edits (Units of Service)
For example, CPT code 94002 describes all ventilation assist and management for the
initial day of observation or inpatient hospital care. Therefore, CPT code 94002 may be
reported with a maximum of one unit of service for a single date of service. If units of
service in excess of one are reported, the MUE prevents payment.

National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
CPT Category III Codes (0001T-0999T)
(Temporary CPT Codes for Emerging Technology,
Services, and Procedures)
Correspondence Language Policy/Example Number 2.0000T – HCPCS/CPT
procedure code definition
For example, the code descriptor for CPT code 0178T is “Electrocardiogram, 64 leads
or greater, with graphic presentation and analysis; with interpretation and report”, and
the code descriptor for CPT code 0180T is “Electrocardiogram, 64 leads or greater, with
graphic presentation and analysis; interpretation and report only”. Therefore, based
upon the code descriptors the procedure described by CPT code 0180T is a component
of the procedure described by CPT code 0178T, and CPT code 0180T is bundled into
CPT code 0178T.
Correspondence Language Policy/Example Number 3.0000T - CPT Manual or CMS
manual coding instruction
For example, the parenthetical note after CPT code 0073T states: “(Do not report 0073T
in conjunction with 77401-77416, 77418).” Therefore, CPT code 77401 cannot be
reported separately in addition to CPT code 0073T, and CPT code 77401 is bundled
into CPT code 0073T.
Correspondence Language Policy/Example Number 4.0000T - Mutually exclusive
procedures
For example, CPT codes 0101T and 0102T describe extracorporeal shock wave
procedures involving different anatomic parts of the musculoskeletal system. CPT code
0101T describes extracorporeal shock wave involving an unspecified part of the
musculoskeletal system and CPT code 0102T describes extracorporeal shock wave
involving the lateral humeral epicondyle. Since both extracorporeal shock wave
procedure codes should not be reported for the same patient at the same anatomic site,
the two procedures are mutually exclusive of one another.

Correspondence Language Policy/Example Number 6.0000T – CPT “separate
procedure” definition
For example, the code descriptor for CPT code 49000 (“Exploratory laparotomy,
exploratory celiotomy with or without biopsy(s) (separate procedure)”) includes the
“separate procedure” designation. When a transluminal peripheral atherectomy of the
abdominal aorta (CPT code 0236T) is performed, the procedure described by CPT code
49000 does not meet the definition of a “separate procedure”. Therefore, CPT code
49000 cannot be reported separately and is bundled into CPT code 0236T.
Correspondence Language Policy/Example Number 7.0000T – More extensive
procedure
For example, CPT code 0072T describes focused ultrasound ablation of uterine
leiomyomata of a volume greater than or equal to 200 cc of tissue. CPT code 0071T
describes focused ultrasound ablation of uterine leiomyomata of a volume less than 200
cc of tissue. Since CPT code 0072T is a more extensive procedure than CPT code
0071T, CPT code 0071T is bundled into CPT code 0072T.
Correspondence Language Policy/Example Number 10.0000T - Standards of
medical/surgical practice
For example, CPT code 0075T describes percutaneous transcatheter placement of
extracranial vertebral or intrathoracic carotid artery stent(s). Since intravenous insertion
of a catheter (CPT code 36000) is a standard of medical/surgical practice for this
procedure, CPT code 36000 is bundled into CPT code 0075T.
Correspondence Language Policy/Example Number 11.0000T - Anesthesia
service included in surgical procedure
For example, if the physician performing a transluminal peripheral atherectomy, open or
percutaneous, including radiological supervision and interpretation of the abdominal
aorta (CPT code 0236T) also provides anesthesia for the procedure, the anesthesia
service is not separately reported. Therefore, CPT code 01926 (“Anesthesia for
therapeutic interventional radiological procedures involving the arterial system;
intracranial, intracardiac, or aortic”) is bundled into CPT code 0236T.

Correspondence Language Policy/Example Number 14.0000T - Misuse of column
two code with column one code
For example, CPT code 0051T describes implantation of a total replacement heart
system (artificial heart) with recipient cardiectomy. CPT code 39010 describes a
mediastinotomy for exploration, drainage, removal of foreign body, or biopsy by a
transthoracic approach. It is a misuse of CPT code 39010 to report a mediastinotomy
for the surgical approach to perform the procedure coded as CPT code 0051T.
Therefore, CPT code 39010 should not be reported with CPT code 0051T.
Correspondence Language Policy/Example Number 15.0000T – Medically Unlikely
Edits (Units of Service)
For example, CPT code 0181T (Corneal hysteresis determination, by air impulse
stimulation, bilateral, with interpretation and report) may be reported with a maximum of
one unit of service since the code descriptor indicates that it is a bilateral procedure. If
units of service in excess of one are reported, the MUE prevents payment.

National Correct Coding Initiative’s
Correspondence Language
Section-specific Examples
HCPCS Level II Codes A0000-V9999
Correspondence Language Policy/Example Number 2.A-V - HCPCS/CPT
procedure code definition
For example, the code descriptor for HCPCS code G0398 is “Home sleep study test
(HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG,
EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation”, and the code
descriptor for CPT code 93041 is “Rhythm ECG, 1-3 leads; tracing only without
interpretation and report”. Based upon the code descriptors an ECG is a component of
the home sleep study test. Therefore, CPT code 93041 is bundled into HCPCS code
G0398.
Correspondence Language Policy/Example Number 3.A-V - CPT Manual or CMS
manual coding instruction
For example, the CPT Manual instruction above CPT code 49320 states: “Surgical
laparoscopy always includes diagnostic laparoscopy. . .” Therefore the surgical
laparoscopic procedure described by the column one HCPCS code G0342
(Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion)
includes the diagnostic laparoscopic procedure described by the column two CPT code
49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without
collection of specimen(s) by brushing or washing (separate procedure)). Based on the
CPT Manual instruction CPT code 49320 is bundled into HCPCS code G0342.
Correspondence Language Policy/Example Number 4.A-V - Mutually exclusive
procedures
For example, HCPCS code G0105 describes colorectal cancer screening by
colonoscopy, and HCPCS code G0120 describes such screening by barium enema.
Since both methods would not be performed at the same patient encounter, the two
procedures are mutually exclusive of one another.

Correspondence Language Policy/Example Number 6.A-V – CPT “separate
procedure” definition
For example, the code descriptor for CPT code 49000 (“Exploratory laparotomy,
exploratory celiotomy with or without biopsy(s) (separate procedure)”) includes the
“separate procedure” designation. When a laparotomy for islet cell transplantation
(HCPCS code G0343) is performed, the procedure described by CPT code 49000 does
not meet the definition of a “separate procedure”. Therefore, CPT code 49000 may not
be reported separately and is bundled into HCPCS code G0343.
Correspondence Language Policy/Example Number 7.A-V - More extensive
procedure
For example, HCPCS code G0117 describes glaucoma screening performed by an
ophthalmologist or optometrist. HCPCS code G0118 describes glaucoma screening
performed under the direct supervision of an ophthalmologist or optometrist. Since
personal performance of a procedure is more extensive than direct supervision of a
procedure, HCPCS code G0118 is bundled into HCPCS code G0117.
Correspondence Language Policy/Example Number 10.A-V - Standards of
medical/surgical practice
For example, colorectal cancer screening using a barium enema radiologic study as an
alternative to screening by colonoscopy (HCPCS code G0120) includes as a standard
of medical/surgical practice all fluoroscopy (CPT code 76000) necessary to perform the
procedure. Therefore, CPT code 76000 is bundled into HCPCS code G0120.
Correspondence Language Policy/Example Number 11.A-V - Anesthesia service
included in surgical procedure
For example, if the physician performing a bone marrow aspiration with bone marrow
biopsy through the same incision on the same date of service (HCPCS code G0364)
also provides anesthesia for the procedure, the anesthesia service is not separately
reportable. Therefore CPT code 01112 (anesthesia for bone marrow aspiration and/or
biopsy) is bundled into HCPCS code G0364.
Correspondence Language Policy/Example Number 14.A-V - Misuse of column
two code with column one code
HCPCS code G0259 describes an injection procedure for arthrography of the sacroiliac
joint. CPT code 27096 describes an injection procedure of an anesthetic/steroid for
arthrography of the sacroiliac joint. It is a misuse of CPT code 27096 to report it with
HCPCS code G0259 for a procedure on the same sacroiliac joint at the same patient
encounter.
Page 47 of 49
Revision Date (Medicare): 4/1/2014
CPT only copyright 2013 American Medical Association. All rights reserved.

Correspondence Language Policy/Example Number 15.A-V – Medically Unlikely
Edits (Units of Service)
For example, since HCPCS code G0121 (Colorectal cancer screening; colonoscopy on
individual not meeting criteria for high risk) can only be performed once every ten years,
a maximum of one unit of service may be reported for a single date of service. If units
of service in excess of one are reported, the MUE prevents payment.

National Correct Coding Initiative’s
Correspondence Language
Examples of Deleted National Correct Coding Initiative (NCCI) PTP Edits
and Medically Unlikely Edits (MUE)
Correspondence Language Policy/Example Number 13.DELETEPR4 - Deleted
NCCI PTP Edit Example
For example, the edit with column one CPT code 93621 and column two CPT code
93620 was deleted because the 2002 CPT Manual added a reference note following
CPT code 93621 which stated: “(Use 93621 in conjunction with 93620)”. Therefore,
based upon new CPT Manual coding instructions, the edit was deleted.
Correspondence Language Policy/Example Number 16.DELETEPR5 – Deleted
MUE Example
For example, the MUE criterion for CPT code 49200 (excision or destruction, open,
intra-abdominal or retroperitoneal tumors or cysts or endometriomas) was implemented
as “1” on January 1, 2007. Since this code was deleted from the CPT Manual on
January 1, 2008, the MUE for the code was deleted December 31, 2007.

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CORRECT CODING INITIATIVE’S 81001 Ncci Correspondence Language Manual

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