Radiology Coding Alert

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?

Answer: If the codes are not listed, the codes are not bundled under the Correct Coding Initiative (CCI) edit pairs. So most likely, 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 warranted.

A private payer could have a black box edit, though. You would need to check with a rep for a recommendation. In addition, the CCI Manual (www.cms.gov/NationalCorrectCodInitEd/) and CPT guidelines may offer broad instructions on types of services that generally should not be reported together. You also should be sure you check both nonmutually exclusive and mutually exclusive CCI edits.

Remember: Just because a code does not have a bundle in CCI does not mean a modifier is out of the picture. Even if you don't need a CCI modifier to override an edit, you might need a payment modifier for a code.

You can find Medicare's other allowed modifiers for any CPT code that's in the Medicare Physician Fee Schedule (MPFS). Columns Y-AC indicate whether certain modifiers, such as modifier 50 (Bilateral procedure), apply.