Cardiology Coding Alert

Question: What does a modifier indicator of 1 mean regarding the CCI edits?

California Subscriber

Answer: CMS created the Correct Coding Initiative (CCI) to promote correct coding and to reduce inaccurate payments. CMS implemented Procedure-to-Procedure (PTP) edits, which indicate the CPT^® and HCPCS code pairs you should normally not report together. Although PTP edits show which CPT^® codes you should not report together, you can append a modifier to override edits — under some circumstances.

Modifier indicator of 1: When there is a modifier indicator of “1” for a PTP edit, this means you can use a modifier to override the edit when appropriate. However, the documentation and clinical circumstances must always support your decision to use the modifier. Examples include separate sites or sessions for the services. Never append a modifier just to bypass the edit.

When you look in the modifier indicator column for PTP edits, you may also see “0” or “9.” Take a look at what those indicators mean so you know how to use them appropriately.

• 0: You cannot use a modifier to override the edit under any circumstances.
• 9: The modifier indicator is irrelevant. The typical example involves CMS deleting an edit retroactively, meaning it's as if the edit never existed.