National Correct Coding Initiative (NCCI) Associated Modifiers

when & how to use NCCI Edit associated modifiers

Each NCCI PTP edit has an assigned modifier indicator.

Modifiers may be appended to HCPCS/CPT codes only if the clinical circumstances justify the use of the modifier. A modifier should not be appended to a HCPCS/CPT code solely to bypass an NCCI PTP edit if the clinical circumstances do not justify its use. If the Medicare program imposes restrictions on the use of a modifier, the modifier may only be used to bypass an NCCI PTP edit if the Medicare restrictions are fulfilled.

NCCI-associated Modifiers

Modifiers that may be used under appropriate clinical circumstances to bypass an NCCI PTP edit include:

Anatomic modifiers

  E1  Upper left, eyelid
  E2  Lower left, eyelid
  E3  Upper right, eyelid
  E4  Lower right, eyelid
  F1  Left hand, second digit
  F2  Left hand, third digit
  F3  Left hand, fourth digit
  F4  Left hand, fifth digit
  F5  Right hand, thumb
  F6  Right hand, second digit
  F7  Right hand, third digit
  F8  Right hand, fourth digit
  F9  Right hand, fifth digit
  FA  Left hand, thumb
  T1  Left foot, second digit
  T2  Left foot, third digit
  T3  Left foot, fourth digit
  T4  Left foot, fifth digit
  T5  Right foot, great toe
  T6  Right foot, second digit
  T7  Right foot, third digit
  T8  Right foot, fourth digit
  T9  Right foot, fifth digit
  TA  Left foot, great toe
  LT  Left side (used to identify procedures performed on the left side of the body)
  RT  Right side (used to identify procedures performed on the right side of the body)
  LC  Left circumflex coronary artery
  LD  Left anterior descending coronary artery
  RC  Right coronary artery
  LM  Left main coronary artery
  RI  Ramus intermedius coronary artery

Global surgery modifiers

  24  Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: The physician may need to indicate that an evaluation and management service was performed during a pos
  25  Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the
  57  Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.
  58  Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: It may be necessary to indicate that the performance of a procedure or service during the postoperative pe
  78  Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: It may be necessary to indicate that another
  79  Unrelated Procedure or Service by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period

Other modifiers

  27  Multiple Outpatient Hospital E/M Encounters on the Same Date: For hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct E/M encounters performed in
  59  Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day.
  91  Repeat Clinical Diagnostic Laboratory Test: In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test resul
  XE  Separate encounter, a service that is distinct because it occurred during a separate encounter
  XS  Separate structure, a service that is distinct because it was performed on a separate organ/structure
  XP  Separate practitioner, a service that is distinct because it was performed by a different practitioner
  XU  Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service

Source: NCCI Policy Manual for Medicare Services, www.cms.gov

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