Radiology Coding Alert

Question: I've been hearing that a lot of the April CCI updates changed modifier indicators retroactive to January. Does that mean we can resubmit the claims for payment?

Maryland Subscriber

Answer: Yes. When Correct Coding Initiative (CCI) edits are modified or deleted retroactive to a specific date, you may resubmit claims denied because of the edit when the date of service is on or after that specific date.

Regarding the April edits, version 17.1's retroactive changes to modifier indicators for the 70000 range largely relate to nuclear medicine services. The column 1 codes all describe radiopharmaceutical therapy. The column 2 codes describe radiopharmaceutical imaging, uptake, and tumor localization, with the exception of 78291 (Peritoneal-venous shunt patency test [e.g., for LeVeen, Denver shunt]).

The change is retroactive to Jan. 1, 2011, so you may resubmit claims denied because of the edits for dates of service between Jan. 1 and March 31.