Q&A: Resolving PTP edits

Q. What are some guidelines for resolving procedure-to-procedure (PTP) edits?

A. To resolve PTP edits, there are several questions that should be addressed for each edit:

1. Are the correct codes reported based on the documentation? It is imperative that the documentation support each of the services rendered and/or all components of the service rendered and reported with codes. Furthermore, any edits must also be resolved in a manner that is supported by documentation.
2. Are the procedures related or connected? Was one service provided in support of the other service? Does the documentation support that the procedures are inclusive or exclusive?
3. Does the documentation support the separateness, unrelatedness, and/or uniqueness of each service? For example, does the documentation support separate procedures or separate anatomical sites?
4. Is a modifier appropriate and, if so, will the edit process differently (e.g., be bypassed) if a modifier is appended?

For more information, see Medicare Billing Edits: A Guide to Regulation, Research, and Resolution.

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