As of 10/1/2010 Medcaid is pretty much following Medicare's lead when it comes to CCI (Correct Coding Initiative) and MUE (Mutually unlikely Edits), there are some exceptions, particularly when it comes to Mod 59.
Examples are Billing a Primary and a Comprehensive code together for the same date of service. In order for that Comprehensive code to get paid, who must add an appropriate modifier ( Anatomical Modifier, 25,59,76, 91 etc).
My issue is this, I audit various facility's that my bill Medi-cal as the Primary carrier and as an example the procedure may be a CT scan w/contrast and also in some cases drugs (J code) may also be given thru an IV (96374).
Because of the contrast medium given for the CT and the IV, I normally amend Mod 59 to 96374 to pass the CCI edit when it comes to Medicare. What do I do when it comes to Medi-Cal. Medi-Cal (California) or Medicaid will not accept Mod 59 on any code other than 2 Hemodialylsis procedures and 1 Ultrasound procedure.
Do I just BYPASS the edit and submit the claim to Medi-Cal ?