tci Medicare Compliance & Reimbursement - 2008 Issue 30

Modifier Errors: Map Out Your Modifier Decisions To Avoid Payer Penalties

Your physician performs two separate procedures that are bundled together under the Correct Coding Initiative (CCI) edits. The bundle has a status of "1," so you can break the bundle with a modifier. You append modifier 59 (Distinct procedural service) to the bundled code, because that's the only one you can use -- right? Actually, no, and this common pitfall sidetracks even the sharpest of coders. Don't rely exclusively on "the modifier of last resort" (modifier 59). This handy flowchart will help you determine your modifier options and select the right modifiers for the case. ...

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