Pathology/Lab Coding Alert

Question: In the National Correct Coding Initiative (NCCI) edits, what do the modifier indicators "0," "1" and "9" mean?


Washington Subscriber

Answer: The NCCI assigns a modifier indicator for each code pair (column 1 and column 2) listed in the edits to tell you which codes you can unbundle and how.

The "0" indicator means you may not use any modifiers to unbundle the edit under any circumstances.

The "1" indicator means you can use an appropriate modifier in some situations to unbundle the edit and receive payment for both codes. For example, NCCI may list two codes as bundled together, but if the pathologist performs the services during separate encounters on the same day, you may be able to report the second code with modifier 59 (Distinct procedural service).

The "9" indicator pertains only to deleted edits and is a bit more tricky to understand. Sometimes when the NCCI decides to delete a bundling edit, the deletion date listed is after the effective date of the edit. This means the edit does not apply to claims you submit for dates of service on or after the deletion date. However, the NCCI will still list the deleted edit with the "0" or "1" modifier indicator to tell you whether you can use a modifier on claims for dates of service before the deletion date.

Other times, the NCCI decides a bundling edit never should have existed, and it deletes the edit retroactively. This means the deletion date and the effective date for the edit will be the same, meaning from now on you can report the previously bundled codes together no matter what the date of service was. The NCCI adds a modifier indicator "9" to these deleted edits to tell you to ignore the edit altogether.