AUGS Continues to Work with CMS on NCCI Edits for Vaginal Hysterectomy

Holiday greetings to all.  Whatever is your traditional holiday, may it be happy, merry, fun, and fulfilling.  May the New Year be filled with promise.  That said….

As we approach the end of the year, I wanted to update you, our AUGS members, regarding the activities of the Society in our efforts to reverse the NCCI edits that impact vaginal hysterectomy and reconstructive procedures, such as colpopexy.

Working in concert with ACOG, SGS, SUFU and AUA, we have just recently received a response from CMS to the arguments that we presented on a conference call meeting on November 17, 2014.  This call was with the medical officers for the Centers for Medicare and Medicaid Services and the staff from the National Correct Coding Initiative (NCCI) to discuss our opposition to the October 1, 2014 edits regarding vaginal hysterectomy.

This response from CMS would be implemented with the April 1, 2015 NCCI Quarterly edits and some edits would be retroactive to October 1, 2014.  In our initial review, there are still concerns regarding some of the edits that CMS included in their response that the societies will look to address with CMS in early January 2015 so they can be included in this April 2015 update. These relate to vaginal hysterectomy codes that also include an enterocele procedure in their descriptor.

Per our initial review of CMS’ response, for those edits from October 1, 2014 where the column 1 code was CPT code 58260, vaginal hysterectomy for uterus of 250 grams or less, CMS is either deleting the edit retroactive to October 1, 2014 or allowing the use of NCCI-approved modifiers to be used to bypass the edit retroactive to October 1, 2014. This would seem to be positive news.     

Once we complete our work with CMS regarding these additional edits that we have concerns about and also complete our review of all the edits, AUGS will be sending out and then posting on our website a grid of these edits and CMS’ response so that you can share that with your billing department prior to April 1, 2015.

However, in the meantime, now that we know that at least some of the edits will be retroactive to October 1, 2014, it is imperative that AUGS members talk with your billing staff to determine what you need to be collecting and saving to be able to process or re-process claims against these potentially retroactive edits.  All AUGS members need to contact their coding and billing departments regarding this possibility.  

As always, if you have any questions, please contact AUGS at [email protected].

Sincerely,


Amy Rosenman, MD
AUGS President