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Blog: Not all CPT Codes are Equal When it Comes to CCI

Written by: Dennis Stevenson Jr., MBA on Tuesday, April 18, 2017 Posted in:

faq

Apply modifiers correctly if you want to resolve the conflict

One of the questions I get a lot when talking to clients is, “How do I resolve CCI conflicts on my charges?” Even when your software identifies the conflict, someone still needs to resolve it. For therapists who are not familiar with the National Correct Coding Initiative (CCI), this can be a very frustrating topic.

The first step to getting comfortable with CCI errors is to understand that there are two different kinds of errors being reported.

  • Mutually exclusive charges that can never go together for the same patient on the same day
  • Charges that require a modifier to explain why the charges should be allowed together

In the first situation, MUTUALLY EXCLUSIVE, there is no resolution other than removing one of the charges from the claim. If you are using charge capture as a metric for productivity, you could mark one of them as non-billable to prevent the conflict from arising.

In the second situation, MODIFIER REQUIRED, you can apply a modifier (XE, XP, XS, XU, or 59) to one of the charges, and the combination will be allowed. But here’s the kicker – you must put the modifier on the correct charge or the conflict won’t be resolved!  Yes, for every conflict, one of the two charges will be identified as requiring the modifier. Putting the modifier on the other charge won’t have any effect.

Discover how to steer clear of CCI conflicts

I often hear clients talking about managing CCI errors by:

  • Applying the modifier to the last charge entered
  • The OT (or SLP) always putting the modifier on their charge

These are not valid strategies for resolving CCI conflicts. They ignore the instructions that have been provided regarding the specific charge that requires the modifier. Hopefully, your software tells you which charge needs the modifier. If not, I’ve included below a list of common therapy current procedural terminology (CPT) codes and the conflicts that they generate – and I tell you exactly which CPT code needs the modifier. I’ve also provided a list of CPT codes that are exclusive and can’t be submitted together.

The most important advice I can provide initially is to pay attention to the messages that arise when you encounter a CCI conflict.  Is the conflict one of the types that will accept a CCI code? Or is it the kind that needs to be managed by removing one of the charges? This will be your biggest clue as to what steps you should take to resolve the conflict.

To use the list below, search using your browser’s “find” function (typically control + F). Search for one of the CPT codes and find the combination that you’re dealing with.  For each CPT Code combination, I’ve provided how you can resolve the conflict.

 

CPT Code Combinations How to Resolve the CCI Conflict
 90901 and 64550 Add modifier to CPT code 64550
 92507 and 97110 Add modifier to CPT code 97110
 92507 and 97112 Add modifier to CPT code 97112
 92507 and 97150 Add modifier to CPT code 97150
 92507 and 97530 Add modifier to CPT code 97530
 92507 and 97532 Add modifier to CPT code 97532
 92508 and 97110 Add modifier to CPT code 97110
 92508 and 97112 Add modifier to CPT code 97112
 92508 and 97150 Add modifier to CPT code 97150
 92508 and 97530 Add modifier to CPT code 97530
 92508 and 97532 Add modifier to CPT code 97532
 92526 and 92520 Add modifier to CPT code 92520
 92526 and 97032 These CPT codes cannot be billed together on the same day
 92526 and 97110 Add modifier to CPT code 97110
 92526 and 97112 Add modifier to CPT code 97112
 92526 and 97150 Add modifier to CPT code 97150
 92526 and 97530 Add modifier to CPT code 97530
 92526 and 97532 Add modifier to CPT code 97532
 92526 and G0283 These CPT codes cannot be billed together on the same day
 92607 and 92507 Add modifier to CPT code 92507
 92607 and 92508 Add modifier to CPT code 92508
 92607 and 92609 Add modifier to CPT code 92609
 92609 and 92507 Add modifier to CPT code 92507
 92609 and 92508 Add modifier to CPT code 92508
 92611 and 92610 Add modifier to CPT code 92610
 92612 and 92520 These CPT codes cannot be billed together on the same day
 92612 and 92610 Add modifier to CPT code 92610
 92612 and 92611 Add modifier to CPT code 92611
 97001 and 95852 These CPT codes cannot be billed together on the same day
 97001 and 97750 These CPT codes cannot be billed together on the same day
 97001 and 97762 These CPT codes cannot be billed together on the same day
 97002 and 95852 These CPT codes cannot be billed together on the same day
 97002 and 97750 These CPT codes cannot be billed together on the same day
 97002 and 97762 These CPT codes cannot be billed together on the same day
 97003 and 95852 These CPT codes cannot be billed together on the same day
 97003 and 97750 These CPT codes cannot be billed together on the same day
 97003 and 97762 These CPT codes cannot be billed together on the same day
 97004 and 95852 These CPT codes cannot be billed together on the same day
 97004 and 97750 These CPT codes cannot be billed together on the same day
 97004 and 97762 These CPT codes cannot be billed together on the same day
 97012 and 97002 Add modifier to CPT code 97002
 97012 and 97004 Add modifier to CPT code 97004
 97012 and 97018 Add modifier to CPT Code 97018
 97016 and 97002 Add modifier to CPT Code 97002
 97016 and 97004 Add modifier to CPT Code 97004
 97016 and 97018 Add modifier to CPT Code 97018
 97016 and 97026 Add modifier to CPT Code 97026
 97018 and 97002 Add modifier to CPT Code 97002
 97018 and 97004 Add modifier to CPT Code 97004
 97022 and 97002 Add modifier to CPT Code 97002
 97022 and 97004 Add modifier to CPT Code 97004
 97022 and 97602 Add modifier to CPT Code 97602
 97026 and 97002 Add modifier to CPT Code 97002
 97026 and 97004 Add modifier to CPT Code 97004
 97032 and 64550 Add modifier to CPT Code 64550
 97032 and 97002 Add modifier to CPT Code 97002
 97032 and 97004 Add modifier to CPT Code 97004
 97033 and 97002 Add modifier to CPT Code 97002
 97033 and 97004 Add modifier to CPT Code 97004
 97034 and 97002 Add modifier to CPT Code 97002
 97034 and 97004 Add modifier to CPT Code 97004
 97035 and 97002 Add modifier to CPT Code 97002
 97035 and 97004 Add modifier to CPT Code 97004
 97110 and 97002 Add modifier to CPT Code 97002
 97110 and 97004 Add modifier to CPT Code 97004
 97112 and 97002 Add modifier to CPT Code 97002
 97112 and 97004 Add modifier to CPT Code 97004
 97112 and 97022 Add modifier to CPT Code 97022
 97113 and 97002 Add modifier to CPT Code 97002
 97113 and 97004 Add modifier to CPT Code 97004
 97113 and 97022 Add modifier to CPT Code 97022
 97113 and 97110 Add modifier to CPT Code 97110
 97116 and 97002 Add modifier to CPT Code 97002
 97116 and 97004 Add modifier to CPT Code 97004
 97124 and 97002 Add modifier to CPT Code 97002
 97124 and 97004 Add modifier to CPT Code 97004
 97140 and 95852 Add modifier to CPT Code 95852
 97140 and 97002 Add modifier to CPT Code 97002
 97140 and 97004 Add modifier to CPT Code 97004
 97140 and 97018 Add modifier to CPT Code 97018
 97140 and 97124 These CPT codes cannot be billed together on the same day
 97140 and 97750 Add modifier to CPT Code 97750
 97150 and 97002 Add modifier to CPT Code 97002
 97150 and 97004 Add modifier to CPT Code 97004
 97150 and 97124 Add modifier to CPT Code 97124
 97150 and 97532 Add modifier to CPT Code 97532
 97150 and 97533 Add modifier to CPT Code 97533
 97150 and 97535 Add modifier to CPT Code 97535
 97150 and 97537 Add modifier to CPT Code 97537
 97150 and 97542 Add modifier to CPT Code 97542
 97150 and 97760 Add modifier to CPT Code 97760
 97150 and 97761 Add modifier to CPT Code 97761
 97530 and 95852 These CPT codes cannot be billed together on the same day
 97530 and 97002 Add modifier to CPT Code 97002
 97530 and 97004 Add modifier to CPT Code 97004
 97530 and 97113 Add modifier to CPT Code 97113
 97530 and 97116 Add modifier to CPT Code 97116
 97530 and 97532 Add modifier to CPT Code 97532
 97530 and 97533 Add modifier to CPT Code 97533
 97530 and 97535 Add modifier to CPT Code 97535
 97530 and 97537 Add modifier to CPT Code 97537
 97530 and 97542 Add modifier to CPT Code 97542
 97530 and 97750 Add modifier to CPT Code 97750
 97532 and 97002 Add modifier to CPT Code 97002
 97532 and 97004 Add modifier to CPT Code 97004
 97533 and 97002 Add modifier to CPT Code 97002
 97533 and 97004 Add modifier to CPT Code 97004
 97535 and 97002 Add modifier to CPT Code 97002
 97535 and 97004 Add modifier to CPT Code 97004
 97537 and 97002 Add modifier to CPT Code 97002
 97537 and 97004 Add modifier to CPT Code 97004
 97542 and 97002 Add modifier to CPT Code 97002
 97542 and 97004 Add modifier to CPT Code 97004
 97597 and 97002 Add modifier to CPT Code 97002
 97597 and 97022 Add modifier to CPT Code 97022
 97598 and 97002 Add modifier to CPT Code 97002
 97598 and 97022 Add modifier to CPT Code 97022
 97598 and 97597 These CPT codes cannot be billed together on the same day
 97602 and 97002 Add modifier to CPT Code 97002
 97750 and 95852 These CPT codes cannot be billed together on the same day
 97750 and 97150 These CPT codes cannot be billed together on the same day
 97760 and 97002 Add modifier to CPT Code 97002
 97760 and 97004 Add modifier to CPT Code 97004
 97760 and 97016 Add modifier to CPT Code 97016
 97760 and 97110 Add modifier to CPT Code 97110
 97760 and 97112 Add modifier to CPT Code 97112
 97760 and 97116 Add modifier to CPT Code 97116
 97760 and 97124 Add modifier to CPT Code 97124
 97760 and 97140 Add modifier to CPT Code 97140
 97761 and 97002 Add modifier to CPT Code 97002
 97761 and 97004 Add modifier to CPT Code 97004
 97761 and 97016 Add modifier to CPT Code 97016
 97761 and 97110 Add modifier to CPT Code 97110
 97761 and 97112 Add modifier to CPT Code 97112
 97761 and 97116 Add modifier to CPT Code 97116
 97761 and 97124 Add modifier to CPT Code 97124
 97761 and 97140 Add modifier to CPT Code 97140
 97761 and 97760 Add modifier to CPT Code 97760
 G0283 and 97002 Add modifier to CPT Code 97002
 G0283 and 97004 Add modifier to CPT Code 97004
 G0283 and 97032 Add modifier to CPT Code 97032

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