For Modifier Details, Explore CCI, Fee Schedule

Scenario: In your day to day coding, you may sometimes get denials that appear to be related to bundling issues; however you may not find the two-day code pair in the CCI edits. How can you find out which is the column 2 code so that you can put the modifier on the correct code?

If you cannot find the codes listed in the Correct Coding Initiative (CCI) edit tables, then they are not bundled under that system. See to it that you check both the mutually exclusive and non-mutually exclusive edit tables.

If your code pair is not bundled under correct coding initiative, then you would not need a CCI modifier such as 25 (Significant, separately identifiable E&M 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 pair.

You need to tread carefully: Just because a code does not have a bundle in correct coding initiative does not mean a modifier is out of the picture. While you will not need a CCI modifier to override the edit, you might need a payment modifier.

You can get Medicare's other allowed modifiers for any given CPT code in the Medicare Physician Fee Schedule (MPFS)(http://www.supercoder.com/coding-tools/fee-schedules). Columns Y-AC indicate if a modifier such as 50 (Bilateral procedure), and the like, applies. For more on this, sign up for a medical coding guide like Supercoder, which comes with a fee schedule tool to help you in your coding job.