National Correct Coding Initiative (NCCI) Associated Modifiers
when & how to use NCCI Edit associated modifiers
Each NCCI PTP edit has an assigned modifier indicator.
- A modifier indicator of "0" indicates that NCCI-associated modifiers cannot be used to bypass the edit.
- A modifier indicator of "1" indicates that NCCI-associated modifiers may be used to bypass an edit under appropriate circumstances.
Modifiers may be appended to HCPCS/CPT codes only if the clinical circumstances justify the use of the modifier. A modifier should not be appended to a HCPCS/CPT code solely to bypass an NCCI PTP edit if the clinical circumstances do not justify its use. If the Medicare program imposes restrictions on the use of a modifier, the modifier may only be used to bypass an NCCI PTP edit if the Medicare restrictions are fulfilled.
NCCI-associated Modifiers
Modifiers that may be used under appropriate clinical circumstances to bypass an NCCI PTP edit include:
Anatomic modifiers | |
E1 | Upper left, eyelid |
E2 | Lower left, eyelid |
E3 | Upper right, eyelid |
E4 | Lower right, eyelid |
F1 | Left hand, second digit |
F2 | Left hand, third digit |
F3 | Left hand, fourth digit |
F4 | Left hand, fifth digit |
F5 | Right hand, thumb |
F6 | Right hand, second digit |
F7 | Right hand, third digit |
F8 | Right hand, fourth digit |
F9 | Right hand, fifth digit |
FA | Left hand, thumb |
T1 | Left foot, second digit |
T2 | Left foot, third digit |
T3 | Left foot, fourth digit |
T4 | Left foot, fifth digit |
T5 | Right foot, great toe |
T6 | Right foot, second digit |
T7 | Right foot, third digit |
T8 | Right foot, fourth digit |
T9 | Right foot, fifth digit |
TA | Left foot, great toe |
LT | Left side (used to identify procedures performed on the left side of the body) |
RT | Right side (used to identify procedures performed on the right side of the body) |
LC | Left circumflex coronary artery |
LD | Left anterior descending coronary artery |
RC | Right coronary artery |
LM | Left main coronary artery |
RI | Ramus intermedius coronary artery |
Global surgery modifiers | |
24 | Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: The physician may need to indicate that an evaluation and management service was performed during a pos |
25 | Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the |
57 | Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service. |
58 | Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: It may be necessary to indicate that the performance of a procedure or service during the postoperative pe |
78 | Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: It may be necessary to indicate that another |
79 | Unrelated Procedure or Service by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period |
Other modifiers | |
27 | Multiple Outpatient Hospital E/M Encounters on the Same Date: For hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct E/M encounters performed in |
59 | Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. |
91 | Repeat Clinical Diagnostic Laboratory Test: In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test resul |
XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
Source: NCCI Policy Manual for Medicare Services, www.cms.gov
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