Neurology & Pain Management Coding Alert

You can override Correct Coding Initiative edits and achieve separate reimbursement for bundled codes -- sometimes. Follow these steps if you have distinct services:

- Check the correct coding modifier indicator. Each CCI code pair edit includes a correct coding modifier indicator of "0" or "1." A "0" indicator means that you may not unbundle the edit combination under any circumstances, according to CCI guidelines. But an indicator of "1" means that you may use a modifier to override the edit if the procedures are distinct from one another.

- Verify that the procedures are independent and distinct. You should attempt to override CCI code pair edits only if the paired procedures are separate and unrelated. For instance, the provider may have provided the services/procedures at different sessions, at different anatomic locations, or for different diagnoses.

- Append modifier 59. You must append modifier 59 (Distinct procedural service) (or another appropriate modifier) to the column 2 code to indicate to the payer that the billed procedures are distinct and separately identifiable. Without modifier 59 or another appropriate modifier, the payer will simply apply the CCI edits and deny payment.

You can access CCI updates through the CMS Web site http://www.cms.hhs.gov/NationalCorrectCodInitEd/. This site contains a listing of the CCI edits by specific CPT sections and is available free for downloading to the public. You can also download a handy how-to article on modifier 59 from the CMS site http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf.