Using a Modifier to Separate 57410 and 57421? Not So Fast
Published on Tue Jul 27, 2004
If your ob-gyn performs vaginal colposcopy with biopsy under anesthesia, don't expect to collect for both 57421 and 57410. Under the new version of the National Correct Coding Initiative (NCCI), carriers will deny the exam charge and will pay only for the colposcopy -- and no modifiers can separate these edits. Medicare considers the exam to be a standard surgical practice. Version 10.2 of the NCCI contains edits for permanently bundled codes. Because these edits feature a "0" indicator, carriers will deny these codes if you report them together. "Permanently bundled" means that you cannot separate these code combinations with a modifier (anatomic, staged procedure, or distinct procedure), even if you believe your medical documentation meets the modifier criteria, says Heather Corcoran, coder at CGH Billing in Louisville, Ky. The following chart details some of the new permanently bundled codes that may affect your ob-gyn practice along with the reason for the edit.
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