by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
January 28th, 2015
- Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service
- Coding pairs are part of the National Correct Coding Initiative (NCCI) procedure to procedure edits
- Documentation indicates the service was not part of the usual components of the main service
- Use Modifier XU with the Column 2 procedure code in the NCCI files
- Use Modifier XU only when there is no other modifier to describe the situation
- Code pairs are not part of the NCCI procedure to procedure edits
- If another valid modifier exists to identify the service does not overlap the usual components of the main service - the column 1 procedure code
- Submission of E/M Codes
- Submission of Weekly radiation therapy management codes (CPT 77427)
- The NCCI code files show the modifier application as "0"
- Documentation supports the service is a component of the main service
- Exact same procedure code performed twice on the same day
- Multiple administration of injections of the same drug
- Submitted with Modifier 59
- NCCI listings can be found on the CMS Website
- Medicare considers two physicians in the same group with the same specialty performing services on the same day the same physician.
- Providers should evaluate other modifiers such as the RT/LT identifying right and left, F1 - F0 to identify fingers, T1-T0 to identify toes and E1-E4 to identify eyelids. Evaluate additional modifiers to determine appropriate usage.