Neurosurgery Coding Alert

Question: What does a modifier indicator mean regarding the CCI edits?

Florida Subscriber

Answer: CMS created the Correct Coding Initiative (CCI) to promote correct coding and to reduce inaccurate payments.

CMS implemented Procedure-to-Procedure (PTP) edits, which indicate the CPT^® and HCPCS code pairs you should normally not report together. Although PTP edits show which CPT^® codes you should not report together, you can append a modifier to override edits - under some circumstances.

To learn whether overriding a particular edit is allowed, you will look in the modifier indicator column, which contains either a 0, 1, or 9.

Learn what the modifier indicators mean to ensure you append them appropriately:

• 0: You cannot use a modifier to override the edit under any circumstances.
• 1: You can use a modifier to override the edit when appropriate. Remember: The documentation and clinical circumstances must always support your decision to use the modifier. Examples include separate sites or sessions for the services. Never append a modifier just to bypass the edit.
• 9: The modifier indicator is irrelevant. The typical example involves CMS deleting an edit retroactively, meaning it's as if the edit never existed.