CMS 2022 National Correct Coding Initiative (NCCI) Policy Manual Released

CMS has released the 2022 Medicare NCCI policy manual with an effective date of 1/1/2022. There are relatively minor changes for pathology and laboratory services found in Chapter 10 of the manual. All updates to policies are noted in red font. 

One item of note is a discussion regarding billing for reflex testing and those tests that require an additional order from the treating physician (page X-4). 

Section N.7 of the manual provides guidelines regarding the reporting of codes 80503-80506 for clinical pathology services (page X-21):

• Reporting is based on the total time for pathology clinical consultation services or the level of medical decision-making performed on the date of consultation.
• Written order from the treating physician is required. Standing orders are not an acceptable substitute. 
• Consultation must be related to an abnormal test result requiring medical judgment that cannot be provided by a laboratory scientist, technologist, or technician.
• A written report must be stored in the patient medical record. 

Codes 80503-80506 are not reported for consultations for laboratory services that have a physician interpretation. Review the XiFin Blog “Pathology Clinical Consultations 2022 Code Additions” for additional information on codes 80503-80506.
 

Source: https://www.cms.gov/files/document/chapter10cptcodes80000-89999final11.pdf