EM Coding Alert
Check for Bundling Before Attaching Modifier
Question: Sometimes I cannot find the two codes I intend to bill in the CCI edits. How do I know which code would be considered a column 1 code, and which would be considered a column 2 code, which requires a modifier?
Answer: If the codes are not listed in the Correct Coding Initiative (CCI), the codes are not bundled. You would not need a modifier to override a non-existent edit. If the codes are not listed in CCI, simply report them as you normally would without a bundle-breaking modifier.
A private payer could have their own black box edits including several unknown and non-reported edit pairs. You would need to check with a payer representative for a recommendation and a listing of any black box edits.
You can also find Medicare’s other allowed modifiers in the Medicare Physician Fee Schedule. Columns Y-AC indicate if modifiers 50, 51 etc. apply. This info is also in Codify’s fee schedule information (https://www.aapc.com/codify/medicare-fee-schedules.aspx)
Codify Member
EM Coding Alert
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