If I want to determine what codes/procedures are paired with a certain code, how can I find this out?
NTIS provides the printed versions of column 1/column 2 correct coding edits and mutually exclusive code edits sorted/sequenced in two ways – by column 1 code and by column 2 code. If a single code is found in both sorts, then you should have all the current code combinations active in the CCI with this certain code in either the column 1 or column 2 position. The NTIS electronic version allows you to search for a code in the database in either position. CMS provides the electronic version of column 1/column 2 correct coding edits and the mutually exclusive code edits. Both tables are sorted by column 1 and column 2 edits.
How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit (MUE) value?
since each line of a claim is adjudicated separately against the MUE value for the code on that line, the appropriate use of Current Procedural Terminology (CPT) modifiers to report the same code on separate lines of a claim will enable a provider/supplier to report medically reasonable and necessary units of service in excess of an MUE value. CPT modifiers such as -76 (repeat procedure by same physician), -77 (repeat procedure by another physician), anatomic modifiers (e.g., RT, LT, F1, F2), -91 (repeat clinical diagnostic laboratory test), and -59 (distinct procedural service) will accomplish this purpose. Modifier -59 should be utilized only if no other modifier describes the service
