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Primary Care Coding Alert

Reader Questions:

No CCI Bundle? Here's Where to Find Modifier Details

Published on Tue Jul 27, 2010

Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which code would be considered a column 1 code and which would be considered a column 2 code, so that I could put my modifier on the correct code?Codify MemberAnswer: If the codes are not listed, the codes are not bundled per the Correct Coding Initiative (CCI). You would not need a CCI modifier, such as 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit when appropriate.A private payer could have a black box edit. You would need to check with a rep for a recommendation.Watch out: Just because a code does not have a bundle in CCI does not mean a modifier is out of the picture. [...]
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