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Ophthalmology and Optometry Coding Alert

Reader questions:

Explore CCI, Fee Schedule for Modifier Details

Published on Tue Jan 11, 2011

Question: We sometimes get denials that appear to be related to bundling issues but I can't find the two-code pair in the CCI edits. How can I find out which is the column 2 code so that I can put the modifier on the correct code?Answer: If you can't find the codes listed in the Correct Coding Initiative (CCI) edit tables, then they're not bundled under that system. Make sure you check both the mutually exclusive and nonmutually exclusive edit tables and you are looking at the CCI Edit tables specific to the date of service of the claim. CCI Edits are updated every three months and need to be referenced accordingly.If your code pair is not bundled under CCI, then you would not need a CCI modifier such as 59 (Distinct procedural service), to override the edit pair.Example: The ophthalmologist saw a glaucoma patient and performed a gonioscopy. The [...]
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