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Urology Coding Alert

CCI:

Don't Rely on Modifier 59 Alone to Bypass CCI Edits, CMS Says

Published on Tue Dec 18, 2012

Key: Get to know modifiers 24 and 57 better. You’ve heard the Correct Coding Initiative (CCI) mantra: If the CCI bundle has a modifier indicator of "1," you can separate the bundle using modifier 59 "or another suitable modifier." Have you ever wondered what the other "suitable modifiers" really are? CMS now adds to the list of applicable modifiers, with the introduction of four more modifiers that Medicare contactors will accept to bypass CCI edits. Review the Rule of Thumb When a CCI coding combination is listed as either a mutually exclusive or comprehensive/component edit, the general rule is that both codes cannot be reported separately. However, two CCI indicators are commonly used to indicate when you can, in fact, report the procedures together under certain circumstances. An indicator of "0" indicates that it is never acceptable to bill these procedures together, and an indicator of "1" indicates that these [...]
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