Use of NCCI edit with Procedure codes

We know that there are few procedures, which have to be coded with modifiers to provide extra information regarding the procedure performed. As there are many procedures can be done on same day if the diagnosis is not by found easily, hence is such can procedures overlap each other and the payment to the physician is affected. So, to solve this overlap condition we use modifiers to modify the procedure and give certain critical information performed before, during or after the procedures. Let us understand these things with few examples.

Read also: When to use Modifier 58, 78 and 79 with CPT codes

In radiology coding, we code X rays of chest, abdomen, extremities, spine etc. and sometimes we come across many CCI edit situations. The most common, which I have come across, is with X rays of chest. Whenever there is two view of chest 71046 performed with one view of chest 71045 on same day, there is CCI edit involved. So in such cases we use 59 modifier to bypass the edit with low RVU cpt that is one view of chest x ray 71045.

71045 Radiologic examination, chest; single view

71046 2 views

Also, there are few procedures like x ray of right hand for three views (CPT code 73130,RT) and x ray of right finger for 2 views (CPT code 73140,RT) of same side performed on same day. When we code both procedures together, there is CCI edit between these procedures. Because the hand involves finger as well it is obvious why there is need of performing another separate procedure for finger X ray. So, to bypass the CCI we have to use 59 or X{EPSU} modifier here with X ray of finger 73140. Hence, in such cases we have to more careful when to use CCI edit with CPT codes.

73130 Radiologic examination, hand; minimum of 3 views

73140 Radiologic examination, finger(s), minimum of 2 views

When not to used modifier with procedure code

There are few cases when we are not allowed to add any modifier to any procedure because that whole procedure is involved in the primary procedure. So, if such the main primary procedure will be only paid even if you the other procedure. The secondary procedure will get denied when it is totally inclusive in the primary procedure. Let understand with and example.

For modified barium swallow 74230 and Normal Barium swallow 74220, when performed on same day in same setting; we are not allowed to use any modifier with the procedure code. Normal barium swallow is a part of Modified barium swallow hence it is totally inclusive or a combine exam with modified barium swallow hence cannot be paid separately with Modified barium swallow. So, be careful while coding Normal barium swallow along with modified barium swallow since both cannot be coded together as per coding guidelines.