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Pediatric Coding Alert

Reader Questions:

Consider Other Sources When CCI Doesn't Provide Info

Published on Fri Mar 18, 2011

Question:Thank you for your new series on Correct Coding Initiative (CCI) edits. 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?Answer:If the codes are not listed in the CCI edits, the codes are not bundled under the Correct Coding Initiative (CCI) edit pairs. So most likely, you would not need a CCI modifier, such as 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit when warranted.However, a private payer could have a specific coding policy that precludes you from reporting certain codes together even if they aren't bundled according [...]
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