How to Use Modifier Indicators with NCCI Edits (2018-10-31)

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
October 31st, 2018

To verify if clinical circumstances might justify the use of a modifier when billing code pairs, look at the NCCI edits and the modifier indicator.  Medicare may have restrictions on the use of a modifier used to bypass an edit.  This important part of coding can alert a payer or auditor if used inappropriately. 

MODIFIER INDICATOR  DEFINITION

0 (Not Allowed) There are no modifiers associated with NCCI that are allowed to be used with this PTP code pair; there are no circumstances in which both procedures of the PTP code pair should be paid for the same beneficiary on the same day by the same provider.

1 (Allowed) The modifiers associated with NCCI are allowed with this PTP code pair when appropriate.

9 (Not Applicable) This indicator means that an NCCI edit does not apply to this PTP code pair. The edit for this PTP code pair was deleted retroactively.

References:

How to Use Modifier Indicators with NCCI Edits (2018-10-31). (2018, October 31). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/how-to-use-modifier-indicators-with-ncci-edits-32520.html

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)


Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


contact

innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.