* The procedure code is eligible for separate reimbursement according to the status indicators on the CMS fee schedule for the relevant provider type (physician fee schedule, ASC, OPPS, etc). * The medical records documentation supports the appropriate use of modifier 25. All of the required key...
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A: Documentation should clearly indicate special circumstances, such as “A separate incision was made” or “A different modality was used.” Q: What should I do if I think modifier 59 should be added but it’s missing? A: Consult with the provider to determine if the omission was an e...
To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25." Modifier 59 and other NCCI-associated modifiers should NOT be used to bypass a PTP edit unless the proper criteria for use of the modifier are met. Documentation in the ...
5: How can I ensure I’m using the correct modifiers? Refer to the National Physician Fee Schedule Relative Value File to check if a CPT code has separate values for the professional and technical components.
(Refer to the , Chapter 1, for general information about the NCCI program, PTP edits, CCMIs, and NCCI-associated modifiers.) One function of NCCI PTP edits is to prevent payment for codes that report overlapping services except in those instances where the services are "separate and distinct...
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We controlled for potential confounding effects. A three-dimensional bar graph of the resulting six odds ratios (ORs) was used to present the separate effects of exposure. The potential confounding factors were age, occupation, education level, a family history of hypertension, family income, ...
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To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25. THE BASICS OF MODIFIER 59 AND THE NCCI What does not appear in CPT is the most common usage of modifier 59, namely breaking of the code pair edits (a??bundlesa??) ...