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Cardiology Coding Alert

Reader Questions:

Look Beyond CCI for Codes You Shouldn't Pair

Published on Sun Jan 16, 2011

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 [...]
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