kellymb
New
I need the link to a source. I have a customer questioning edits that trigger to indicate modifiers 51 and 59 should be used on the same line item. We have other customers who complain when we don't trigger edits to indicate both are needed.
CPT codes 49324 and 49422 are both subject to multiple procedure payment rules and are part of an NCCI procedure to procedure code pair where a modifier can be used to bypass an NCCI edit. The problem is that these edits are global edits. The customer has the ability to restrict them to a particular payer. They indicate they've been instructed to never bill these modifiers together, but I have not found any documentation from a primary source like the AAPC that says that. There's nothing in the CPT manual that states that.
CPT codes 49324 and 49422 are both subject to multiple procedure payment rules and are part of an NCCI procedure to procedure code pair where a modifier can be used to bypass an NCCI edit. The problem is that these edits are global edits. The customer has the ability to restrict them to a particular payer. They indicate they've been instructed to never bill these modifiers together, but I have not found any documentation from a primary source like the AAPC that says that. There's nothing in the CPT manual that states that.