Wiki CCI Book

[Pat Liebl]

Does anyone know why, when you look in the CCI book to see if a CPT will bundle and you need to add a 59md that the shaded codes are sometimes add on codes. I thought that you do not add a modifier to a add on code? Should I add the 59 because it say so in the CCI book even if its and add on code?

 

[LeslieJ]

I have no understanding of what you mean by "CCI Book" & what it might be telling you. You also don't mention the codes you're looking at, so there isn't any definitive answer that can be given.

However, I can tell you to go here:
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/NCCI_Policy_Manual.zip

And get the NCCI Policy Manual from CMS. This is a zipped file that has a PDF for each chapter of the CPT book. It contains the edits logic behind most of the edits that NCCI has. This is really the best place you can go for answers that will be specific to what you're dealing with.

Generally speaking, no, we shouldn't need to use modifier 59 on add-on codes. In reality, there may be times when it's very appropriate to use modifier 59 on the add-ons & it depends on the code(s) the circumstance. There's no "black & white" solution because the scenarios can vary widely.

Check out the NCCI Policy Manual as it pertains to the CPT code(s) you're looking at - it should help.

Leslie Johnson

 

[Pat Liebl]

CCI= Means Correct Coding Initiative.

 

[mhstrauss]

Pat, do you have any specific examples? I don't use the books, so I'm not familiar with the shading they use, but we can help you better if we know which codes you are having problems with.

Leslie, the same CCI info on the CMS website is available in book form from several vendors; the books are updated quarterly.