edit failure questions. This column 2 has been billed with the same date of service as column 1 Cpt therefore considered to be unbundling. An ncci modifier may be used. This is happening for Cpt 01482 and 6445. 73720 and 73718. 01482 and 64445. 01482 and 64447. What ncci modifier can be used or how can I resolve edits? Thank you
Remember that just because a modifier
can override an edit doesn't mean it
should.
Modifiers should only be appended when the documentation supports them, not simply as a way to force a claim through.
The first step is to review the medical record and determine exactly what services were performed. If a modifier is appropriate, the documentation will point you to the correct one.
Using your example of 73720 and 73718:
73720 = MRI of the lower extremity with and without contrast
73718 = MRI of the lower extremity without contrast
Before considering a modifier, I'd want to review the documentation for information such as (but not limited to):
- Were these performed during the same encounter or on separate encounters?
- Were the MRIs performed on different extremities?
- If so, which leg was imaged for each code?
If both codes represent the same encounter on the same extremity, the services are not separately reportable. In that case, the correct solution isn't to override the edit. You'd bill only the service that the documentation supports.
You'd do the same thing for the anesthesia and injection charges. Why is the injection of anesthetic being billed on the same date as the anesthesia? Follow the documentation, and if a modifier is appropriate, the documentation will lead you to which one to use. And, if the documentation does not support a modifier, bill only the service that is supported by the documentation.