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Otolaryngology Coding Alert

Reader Question:

Look for a '1' Indicator to Unbundle 31255, 31254

Published on Thu Aug 30, 2012

Question: When can I unbundle CCI edits?Georgia SubscriberAnswer: Each Correct Coding Initiative (CCI) code-pair edit includes a correct coding modifier indicator of 0 or 1.A "0" indicator means that you may not unbundle the edit combination under any circumstances, according to CCI guidelines.An indicator of "1," however, means that you may use a modifier to override the edit if the procedures are distinct from one another You should only attempt to override CCI code pair edits if the paired procedures are separate and unrelated, however. For instance, the physician may have provided the services/procedures at different sessions or at different anatomic locations, such as left versus right, or cheek versus forehead.Example: The ENT performs 31255 (Nasal/sinus endoscopy, surgical; with ethmoidectomy, total [anterior and posterior]) on the left side and 31254 (... with ethmoidectomy, partial [anterior]) on the right side. CCI usually bundles 31254 to 31255, but includes a "1" indicator. [...]
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