Q&A: Getting paid for services on the CCI edit list

September 19, 2008

Modifier -59 for services listed in column 2 of the CCI edits is accepted by most major insurers as indication that there was a separate service.

Numerous surgical services we provide to our patients appear on the Correct Coding Initiative (CCI) edit list, and our billing staff spends countless hours battling with insurers to get them paid, even though they are, by diagnosis, different anatomical sites, different sessions on the same date, or separate incisions/excisions. Any "magic bullet" we can use to get claims paid on the first try?

You didn't indicate if you were using modifier –59 (distinct procedural service) when billing services listed in column 2 of the CCI edits. This modifier is accepted by most major insurers as an indicator that there was a separate service. Modifier –59 has been under scrutiny during the past several years for overuse, however, so it may not solve all of your submission issues. But it should cut down on them if you are not already using the modifier. If you are using modifier –59, identify the insurers that are giving you a problem. Meeting with representatives of those insurers, including their medical directors-physician to physician-and outlining your problem may also resolve the issue.