Pathology/Lab Coding Alert

"Correct Coding Initiative (CCI) edit pairs represent services that are bundled components of a more comprehensive service or would not ordinarily be performed together for the same patient on the same day mutually exclusive services," says Cheryl A. Schad, BA, CPCM, CPC, president of Schad Medical Management in Mullica Hill, N.J. Medicare normally will not reimburse both services when they are reported together.

But if the pathologist legitimately carries out two separate, medically necessary services that a CCI Edit pair represents, Medicare may reimburse both with the appropriate modifier. To indicate that codes represent separate services as opposed to unbundling of a single service, you should append modifier -59 (Distinct procedural service) to override the edit. For clinical lab tests conducted more than once a day, use modifier -91 (Repeat clinical diagnostic laboratory test).

Every code pair is assigned a modifier indicator of either "1," which means you can use a modifier with the pair, or "0," which means you cannot use a modifier. "You should never indiscriminately override CCI edit pairs; it should be a rare occurrence," Schad says. "When it is necessary, make sure you have documentation to support medical necessity and to justify the claim of distinct procedural service."