Ophthalmology and Optometry Coding Alert

Question: What modifiers are allowed with the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits?

Louisiana Subscriber

Answer: The presence of an NCCI PTP edit indicates that the two codes generally can’t be reported together. Depending on the circumstances, you can use one of the following modifiers to unbundle an NCCI PTP edit pair:

Anatomic modifiers: E1-E4, FA, F1-F9, TA, T1-T9, LT, RT, LC, LD, RC, LM, RI Global surgery modifiers: 24, 25, 57, 58, 78, 79 Other modifiers: 27, 59, 91, XE, XS, XP, XU

NCCI-associated modifiers allow you to bill certain CPT^® codes together when they are medically appropriate and when the documentation supports the allowance of both CPT^® codes. Normally, the CPT^® codes would be considered inclusive and denied as unbundled. In general, the clinical circumstances that enable you to bypass an NCCI PTP edit relate to separate patient encounters, separate anatomic sites, or separate specimens.