Pathology/Lab Coding Alert

Question: Our lab performed a calcium test, and later the same day, the physician ordered a calcium infusion test. Medicare denied the second test based on a CCI edit, but I can't find the edit on the CCI edit table. What am I missing?

Tennessee Subscriber

Answer: Perhaps you looked for the edit pair on the Correct Coding Initiative (CCI) column 1/column 2 edit table, but you can find the pair on the mutually exclusive table:

• 82310 -- Calcium; total
• 82331 -- ... after calcium infusion test.

The column 1/column 2 edit table generally involves procedures in which the code in column 2 is a component of the column 1 code. In contrast, the mutually exclusive table deals with codes that would rarely be performed together because, for instance, they represents two tests for the same analyte using different methodology.

Whether the edit pair is on the column 1/column 2 table or the mutually exclusive table, you need to look at the modifier indicator column to learn if you can override the edit pair when clinical circumstances warrant doing so.

In your example, because the physician ordered two distinct tests at two separate patient encounters, and the CCI table modifier indicator is "1" (modifier allowed), you should bill the service as 82310, 82331-59 (Distinct procedural service).

You can find the CCI edits on the CMS website at http://www.cms.gov/NationalCorrectCodiNitEd/01_overview.asp . Or, you can use a CCI edit look-up tool at https://www.aapc.com/codes/.