Ophthalmology and Optometry Coding Alert

Question: Are there specific modifiers that I should use to unbundle a National Correct Coding Initiative (NCCI) Procedure-to- Procedure (PTP) edit pair?

New Mexico Subscriber

Answer: Yes. NCCI-associated modifiers allow for certain CPT^® codes to be billed together when the procedures are medically appropriate and when the documentation supports the allowance of both CPT^® codes. Normally, the CPT^® codes would be considered inclusive and denied as unbundled.

NCCI edits are likely to apply when multiple procedures are performed on the same day. When the clinical circumstances call for bypassing an NCCI PTP edit — separate patient encounters, separate anatomic sites, separate specimens — you may be able to use the following modifiers to unbundle the edit pair:

• Global surgery modifiers: 24, 25, 57, 58, 78, 79
• Anatomic modifiers: E1-E4, FA, F1-F9, TA, T1-T9, LT, RT, LC, LD, RC, LM, RI
• Other modifiers: 27, 59, 91, XE, XS, XP, XU

Note, not all of these modifiers will apply to every situation. For example, the global surgery modifiers only apply to services performed during the global period, pre- and postoperative care.

Keep in mind: Just because you unbundle two codes doesn’t mean you’ll get fully reimbursed for each. A multiple procedure discount may still apply, depending on your payer’s rules.