Neurology & Pain Management Coding Alert

Question: Sometimes I cannot find my two code pair in the CCI edits. How do I know which code would be considered a column 1 code and which would be considered a column 2 code so that I could put my modifier on the correct code?

Kansas Subscriber

Answer: If the codes are not listed, the codes are not bundled per the Correct Coding Initiative (CCI). You would not need a modifier to override the edit. If the codes are not listed in CCI, simply report them as you normally would without a bundle-breaking modifier.

A private payer could have proprietary bundling edits that may or may not be published, aka black box edits. You would need to check with a payer rep for a recommendation.

You can also find Medicare's other allowed modifiers in the Medicare Physician Fee Schedule. Columns Y-AC indicate if modifier 51, 50 etc. apply. This info is also in Codify's fee schedule information (https://www.aapc.com/codify/medicare-fee-schedules.aspx).