tci Medicare Compliance & Reimbursement - 2014 Issue 5

Reader Question: Know Your Best CCI Modifier Options

Question: Other than modifier 59 (Distinct procedural services), which other modifiers can I use to separate CCI edits when warranted? Answer: Most coders who are trying to separate CCI edits will use either modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or Other Qualified Health Care Professional on the same day of the procedure or other service) for edits involving E/M codes, or modifier 59 for bundles that involve two procedures. However, coding experts have long maintained that modifier 59 should be the modifier “of last resort,” making many coders reluctant to...

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