The Correct Coding Initiative 8.2 edits have arrived, and while the number of new bundles may be overwhelming, savvy coders who know the rules for modifier -59 will be able to garner full reimbursement. Modifier -59 (Distinct procedural service) applies only to specific circumstances in which a procedure that would normally be bundled with another procedure should not be bundled for any of the following reasons:
The CCI edits use three indicators 0, 1 and 9 to reflect whether or not the use of CPT modifier -59 with otherwise bundled codes is appropriate. 0 specifies that no circumstances exist in which appending modifier -59 is appropriate; 1 stipulates that a -59 modifier is allowed because the code that would normally be bundled is distinct or independent from the other services provided that day; 9 indicates there no longer exists a bundling between the specified codes deletion effective the same date as the CCI edits' effective date. New 1 indicator comprehensive/component codes: Be aware that there are an extraordinary number of codes that now include anesthesia code 01995 (Regional intravenous administration of local anesthetic agent or other medication [upper or lower extremity]) that can be unbundled in certain circumstances. New comprehensive codes that can't be unbundled due to the 0 indicator: You should also take notice of the many procedure codes that now include anesthesia code 00170 (Anesthesia for intraoral procedures, including biopsy; not otherwise specified). These bundles, most of which also fall under the 0 indicator, cannot under any circumstance be unbundled.
With respect to the new comprehensive/component codes that can be unbundled due to indicator 1, "these procedures usually are included and only rarely are they unbundled with the appropriate modifier," says Michael X. Repka, MD, AAO representative to the American Medical Association's CPT advisory committee.