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Modifiers - different procedure code

  1. Default Modifiers - different procedure code
    Medical Coding Books
    I am trying to comply with the CMS NCCI edits and have recently gotten a denial. A client came in for a 90846 and a few hours later for a 90806 - 2 appointments in the same day, but a different procedure code. Medicaid said I could try a modifier, but I am slightly confused as to which I should use. Would I used the modifier 25 - for significant, seperately identifiable evaluation and management service by the same physician on the same day of the procedure or other service? Both services were provided by the same clinician, but I know those codes do not fall under E/M codes. Any suggestions?

  2. #2
    I have used modifier 59 to clear up NCCI edits when a provider does a 90847 and a 90806 on the same date of service.

  3. #3
    Newport News, VA
    Smile Modifiers
    I agree with Kilokilo. Modifier 59 is the only modifier that will pull a code out of CCI if it is separately billable per CCI rules.
    Eagle Eye

  4. #4
    I agree with her as well, I will add that when we were audited after having added the modifier, we have been denied because in our case the group and individual were covering the same issue, i.e. depression.

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