Contents
What is an NCCI modifier?
NCCI-associated modifiers are used to indicate the special circumstances such as when the procedures are performed at different anatomic sites, a separate procedure or repeat clinical diagnostic laboratory test. If an edit allows use of NCCI-associated modifiers, the two procedure codes may be reported together.
What is the difference between modifier 52 and modifier 53?
By definition, modifier 53 is used to indicate a discontinued procedure and modifier 52 indicates reduced services. In both the cases, a modifier should be appended to the CPT code that represents the basic service performed during a procedure.
What is a 26 modifier?
Current Procedural Terminology (CPT®) modifier 26 represents the professional (provider) component of a global service or procedure and includes the provider work, associated overhead and professional liability insurance costs. This modifier corresponds to the human involvement in a given service or procedure.
What is a 58 modifier used for?
Submit CPT modifier 58 to indicate that the performance of a procedure or service during the postoperative period was either: Planned prospectively at the time of the original procedure (staged); More extensive than the original procedure; or. For the therapy following a surgical procedure.
What is CCI in medical coding?
CCI Edits. The NCCI is an automated edit system to control specific Current Procedural Terminology (CPT® American Medical Association) code pairs that can or cannot be billed by an individual provider on the same day for the same patient (commonly known as CCI edits).
How do I find my NCCI edits?
The NCCI Policy Manual, MUEs, and PTP edits are accessed through the NCCI Edits webpage. Links to the PTP Coding Edits, Medically Unlikely Edits, and NCCI manual webpages are provided in the menu on the left side of the NCCI Edits webpage.
Can you use modifier 50 and 52 together?
Modifier 50 may not be submitted in combination with modifiers 52, 53, or 73 on the same line item. If the procedure is discontinued, only a unilateral procedure may be reported as discontinued.
When should you use modifier 53?
discontinued services
Modifier 53 is outlined for use on CPT codes in order to indicate discontinued services. This means it should be applied to CPTs which represent diagnostic procedures or surgical services that were discontinued by the provider. Modifier 53 is for professional physician services and would not apply to ASC procedures.
What is 59 modifier used for?
Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.
What is modifier 62 used for?
Modifier 62 The individual skills of two surgeons (each in a different specialty) are required to perform surgery on the same patient during the same operative session.
What is modifier 79 used for?
A new post-operative period begins when the unrelated procedure is billed. We follow the American Medical Association coding guidelines and require the use of Modifier 79 to show that the second procedure by the same physician is unrelated to a prior procedure for which the post-operative period has not been completed.
What is CCI modifier?
What kind of modifiers can you use in NCCI?
A. What modifiers are allowed with the NCCI PTP edits? Modifiers that may be used under appropriate clinical circumstances to bypass an NCCI PTP edit include: Anatomic modifiers: E1-E4, FA, F1-F9, TA, T1-T9, LT, RT, LC, LD, RC, LM, RI Global surgery modifiers: 24, 25, 57, 58, 78, 79 Other modifiers: 27, 59, 91, XE, XS, XP, XU
How to tell if a NCCI edit is a claim line?
The MUE files on the CMS NCCI webpage display an “MUE Adjudication Indicator” (MAI) for each HCPCS/CPT code. An MAI of “1” indicates that the edit is a claim line MUE. An MAI of “2” or “3” indicates that the edit is a date of service MUE. Further information is available in MLN Matters MM8853 (PDF).
Where is the National correct coding initiative ( NCCI ) located?
Information about the National Correct Coding Initiative (NCCI) can be found in the Internet-Only Manual, Publication 100-04, Section 20.9 of Chapter 23 of the Medicare Claims Processing Manual at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs
What is the email address for the NCCI program?
Inquiries about the NCCI program, including those related to NCCI (PTP, MUE and Add-On Code) edits, should be sent to the following email address: [email protected]. O. What determines the Units of Service (UOS) for an MUE?