Originally published October 12, 2017. CMS also offers the more specific X{EPSU} modifiers (XE, XP, XS, XU) as alternatives to 59. Payer rules change; confirm current CMS and payer requirements before billing.
The National Correct Coding Initiative (NCCI) is a set of CMS edits for pairs of procedures that shouldn't be reported together at the same encounter, for example because they are mutually exclusive based on anatomy, timing or sex.
Example: 97140
For 97140 (manual therapy techniques), NCCI links 95851, 95852, 97164, 97168, 97018, 97124, 97530, 97750 and 99186. If you bill any of these with 97140, only 97140 is paid.
NCCI-associated modifiers
If an edit allows an NCCI-associated modifier, the two codes can be reported together. Modifiers may not be used to bypass an edit unless the criteria for that modifier are actually met.
- 59: procedures or services, other than E/M, that are not normally reported together but are appropriate in the circumstances
- 25: a significant, separately identifiable E/M service on the same day as a procedure
- RT, LT: right and left side of the body
- E1–E4: eyelids
- FA, F1–F9: fingers
- TA, T1–T9: toes