tci ED Coding & Reimbursement Alert - 2006 Issue 3

Polish Your Modifier 59 Use And Master NCCI Edits

Crack down on incorrect unbundlingThe National Correct Coding Initiative (NCCI) has been at it again with updated edits for this quarter. NCCI volume 12.0 introduces a startling 59,080 new column 1/column 2 edits and 465 new mutually exclusive edits, and many of these code bundles could warrant a modifier 59 to optimize reimbursement. But watch out--in a recent sampling, the U.S. Office of Inspector General (OIG) found over $59 million in overpayments to providers due to the misuse of modifier 59 (Distinct procedural service). This leaves your carrier no choice but to scrutinize your practice's NCCI...

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