Otolaryngology Coding Alert

Question: When can I unbundle Correct Coding Initiative (CCI) edits?

Georgia Subscriber

Answer: Each CCI code-pair edit includes a correct coding modifier indicator of 0 or 1.

A "0" indicator means that you may not unbundle the edit combination under any circumstances, according to NCCI guidelines.

An indicator of "1," however, means that you may use a modifier to override the edit if the procedures are distinct from one another. You should only attempt to override NCCI code pair edits if the paired procedures are separate and unrelated, however.

For instance, the physician may have provided the services/procedures at different sessions or at different anatomic locations.

Example: The ENT sees a patient in the morning for nasal congestion and nasal polyps. During this visit, the physician performs an E/M service and a nasal endoscopy (9921x-25 and 31231). Then around 7pm, the otolaryngologist goes to the emergency room to control an epistaxis for this same patient, whose nose is very dry and as a result started to bleed uncontrollably. The physician performed a 30903 in the emergency room. CCI bundles 31231 and 30903 with a modifier indicator of "1." Therefore, you can append modifier 59 to 30903 to indicate a separate encounter.