Cardiology Coding Alert

Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which code to consider the column 1 code and which to consider a column 2 code, so that I may put my modifier on the correct code?

Answer: If the codes are not listed, the codes are not bundled under the Correct Coding Initiative (CCI) edit pairs. So most likely, you would not need a CCI modifier, such as 59 (Distinct procedural service), to override the edit when warranted.

A private payer could have a black box edit, though. You would need to check with a rep for a recommendation. In addition, the CCI Manual (www.cms.gov/NationalCorrectCodInitEd/) and CPT guidelines may offer broad instructions on types of services that generally should not be reported together. You also should be sure you've checked both non-mutually exclusive and mutually exclusive CCI edits.

Remember: Just because a code does not have a bundle in CCI does not mean a modifier is out of the picture. Even if you don't need a CCI modifier to override an edit, you might need a payment modifier for a code.