Long gone are the days of reviewing quarterly NCCI column1/column2 edit tables in paper binders to determine if a code pair is billable together. Editing software now allows coders the ability to see all code pair edits with the click of a mouse. The issue now becomes what modifier is appropriate when the documentation supports billing a bundled code pair.

This is where understanding modifiers and their proper use is essential.

The first question on our journey to understanding modifiers is- What exactly are modifiers?

Modifiers are a communication tool. They are a way of informing payers, “Yes, we know these two codes usually don’t go together-but here’s why they do this time.” You’ll want to keep in mind; the documentation is everything. Your modifier is your argument, and your documentation is the evidence that proves your case.

Modifier 59 is often appended to unbundle NCCI code pairs; however, this modifier should only be utilized when no other modifier more appropriately describes the coding scenario. For example, anatomic modifiers F1-LT hand, second digit and F2-LT hand, third digit provide greater specificity for two procedures performed on separate digits. In this case, neither modifier -59 nor -X{EPSU} should be used.

NCCI modifiers help tell the whole story of what happened during a procedure or service. When used correctly, they can prevent denials and support clean claims.

If you would like to know what modifiers can do for you, check out the Ensure Your Correct Modifier Usage in Coding webinar. We will discuss anatomical, global, and other designated modifiers in the context of procedure-to-procedure (PTP) and medically unlike edits (MUE). We will also apply modifiers to NCCI edit case examples.

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