Ophthalmology and Optometry Coding Alert

Can’t make heads or tails of the columns in the Correct Coding Initiative (CCI)? Understanding what’s meant by Column 1 and Column 2 in the CCI code pair tables that Medicare releases quarterly is critical to knowing what procedures you shouldn’t bill together.

Good news: A January 2019 Medicare Learning Network (MLN) publication, “How to Use the Medicare National Correct Coding Initiative (NCCI) Tools,” provides clarity.

Put simply: “Although the Column 2 code is often a component of a more comprehensive Column 1 code, this relationship is not true for many edits,” according to the MLN booklet. “The PTP code pair edit simply represents two codes that should not be reported together, unless an appropriate modifier is used.”

The modifier indicator column is key: If this column shows a “0” next to the edit pair, that means you can’t ever report the two codes together for the same patient on the same date of service; if there’s a “1,” you can append an appropriate modifier, such as modifier 59 (Distinct procedural service), provided your documentation supports separate services during the same session; if you see a “9” next to the pair, this means that a CCI edit “does not apply to this PTP code pair” because the “edit for this PTP code pair was deleted retroactively,” says the MLN publication.

Resource: To learn more and download a copy of the MLN booklet, go to www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html and scroll to Downloads.