CCI Edits - Codes You Shouldn't Pair

Sometimes you might not be able to find your two-code pair in the CCI edits. How would you know which code would be considered as column 1 code and which would be considered as column 2 code in order to put your modifier on the proper code?

If the codes are not listed, the codes are not bundled under the CCI (Correct Coding Initiative ) edit pairs. For that reason, most likely you would need a CCI modifier such as 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit when required.

A private payer could have a black box edit, though. You need to check with a rep for a recommendation. To add to it, the CCI manual and CPT guidelines may offer broad instructions on types of services that normally should not be reported together. You should also be sure you check both non-mutually exclusive and mutually exclusive CCI edits.

But remember that just because a code does not have a bundle in CCI does not mean a modifier is out of the picture. Even if you do not need a CCI modifier to override an edit, you might need a payment modifier for a code.

You can get Medicare's other allowed modifiers for any CPT code that is in the Medicare Physician Fee Schedule (MPFS). Columns Y-AC point to whether certain modifiers such as modifier 50 apply.

Article source :-  http://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/reader-questions-look-beyond-cci-for-codes-you-shouldnt-pair-article