Reader Questions:
Multiple Sources Define Codes You Shouldn't Pair
Published on Thu Jan 06, 2011
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 [...]