NCCI Edit indicator

NCCI Indicators

Each code pair (Column 1/Column 2 correct coding edits and mutually exclusive code edits) is assigned a correct coding modifier indicator of 0, 1 or 9. The indicators mean:

• 0 – There are no modifiers associated with NCCI that are allowed to be used with this code pair; there are no circumstances in which both procedures of the code pair should be paid.

• 1 – The modifiers associated with NCCI are allowed with this code pair when appropriate.

• 9 – This indicator means that NCCI edits do not apply to this code pair. The edits have been deleted for this code pair.

Modifiers
When applicable, the following modifiers should be applied to the Column 2 code to allow payment when the code pair has a 1 indicator:

Anatomical Modifiers

Eye:
E1 Upper left eyelid E3 Upper right eyelid
E2 Lower left eyelid E4 Lower right eyelid
Hand:
FA Left hand, thumb F5 Right hand, thumb
F1 Left hand, second digit F6 Right hand, second digit
F2 Left hand, third digit F7 Right hand, third digit
F3 Left hand, fourth digit F8 Right hand, fourth digit
F4 Left hand, fifth digit F9 Right hand, fifth digit

Foot:
TA Left foot, great toe T5 Right foot, great toe
T1 Left foot, second digit T6 Right foot, second digit
T2 Left foot, third digit T7 Right foot, third digit
T3 Left foot, fourth digit T8 Right foot, fourth digit
T4 Left foot, fifth digit T9 Right foot, fifth digit

Miscellaneous:
LC Left circumflex, coronary artery
RC Right coronary artery
LD Left anterior descending coronary artery
LT Left side
RT Right side

If the code pair has a 0 indicator, payment will not be made for the Column 2 code even if one of the above modifiers is used.

The medical record must reflect that the modifier is being used appropriately to describe separate services. The documentation should be maintained in the patient’s medical record and made available to Medicare upon request.

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