Health Information Management

Tip: Append modifier to correct code

APCs Insider, September 24, 2010

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Each National Correct Coding Edits (NCCI) table contains edits, which are pairs of codes that, in general, should not be reported together.

If a provider reports two codes of an edit pair, the payer will deny the column 2 code and pay the column 1 code. That’s true for the NCCI and Mutually Exclusive Edits tables.

When it’s valid, attach modifier -59 (distinct procedural service) to the applicable column 2 code rather than the column 1 code.

This tip was adapted from "Five myths about correct use of modifier -59 busted" in the September issue of Briefings on APCs.
 



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