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General Surgery Coding Alert

Reader Questions:

Explore CCI, Fee Schedule for Modifier Details

Published on Mon Jan 24, 2011

Question:We sometimes get denials that appear to be related to bundling issues but I can't find the two-code pair in the CCI edits. How can I find out which is the column 2 code so that I can put the modifier on the correct code?Texas SubscriberAnswer: If you can't find the codes listed in the Correct Coding Initiative (CCI) edit tables, then they're not bundled under that system. Make sure you check both the mutually exclusive and non-mutually exclusive edit tables.If your code pair is not bundled under CCI, then you would not 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 pair.Watch out: Just because a code does not have a bundle in CCI does not mean [...]
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