Otolaryngology Coding Alert

Question: When can I unbundle NCCI edits?


Georgia Subscriber

Answer: Each National Correct Coding Initiative (NCCI) 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, at different anatomic locations, or for different diagnoses.

Example: The ENT uses a rigid laryngoscope (31579, Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy) to obtain video scopes to examine vocal fold mobility and laryngeal function. At the same time, he uses a nasal endoscope (31231, Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) to view more clearly the patient's sinuses.

NCCI usually bundles 31231 to 31579, but includes a -1- indicator. In this case, because the ENT provided the services to visualize different areas for separate reasons, you should report both procedures. To support your coding, you should include an appropriate, documented diagnosis for each procedure (for example, 478.4, Polyp of vocal cord or larynx, for the laryngoscopy and 473.9, Unspecified chronic sinusitis, for the endoscopy).

In addition, you must append modifier 59 (Distinct procedural service) to the column 2 code to indicate to the payer that the billed procedures are distinct and separately identifiable. In this example, you would report 31579 and 31231 with modifier 59 appended to clarify that the procedures occur at different anatomic sites.