Ob-Gyn Coding Alert
These Modifiers Can Now Break CCI Edits
Question: I heard we have new modifiers to override Correct Coding Initiative (CCI) edits. What are they?
Answer: CMS Transmittal 1136, released on Nov. 1, announces that you’ll be able to use the following modifiers to override a CCI edit with a modifier of "1" effective Jan. 1, 2013:
LM (Left main coronary artery)
RI (Ramus intermedius)
24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period)
57 (Decision for surgery)
Whereas modifiers LM and RI will mainly be used by heart surgeons, the other two modifiers are quite familiar to most other coders. Both modifiers 24 and 57 can be appended to E/M codes when the E/M service is either unrelated to recovery from surgery (modifier 24) or results in the decision to perform the bundled procedure (modifier 57).
Resource: To read the complete Transmittal, visit www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1136OTN.pdf.
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