tci E/M Coding Alert - 2017 Issue 10

Reader Question: Decipher Modifier Indicator of 1 in CCI Edits

Question: I was looking up CCI edits for 99221 and 99212, and I saw the edits have a modifier indicator of 1. What does this mean? Virginia Subscriber Answer: Via the Correct Coding Initiative (CCI) edits, you will see Procedure-to-Procedure (PTP) edits that indicate the CPT® and HCPCS code pairs you should normally not report together. According to the latest 2017 CCI edits, 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision...

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