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Posted By angie on 10-17-2019, 10:32:09 in Ob-Gyn
can someone explain how they came up with this cci edit that 81241 is bundled with gonorrhea testing 87591 and chlamydia

nfectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique

Code 87591 is a column 2 code for 81241, but you may use a CCI-associated modifier to override the edit under appropriate circumstances.
CCI Edit Rule:
CPT Manual or CMS manual coding instructions

The current CCI-associated modifiers are: E1, E2, E3, E4, FA, F1, F2, F3, F4, F5, F6, F7, F8, F9, LC, LD, LM, RC, RI, LT, RT, TA, T1, T2, T3, T4, T5, T6, T7, T8, T9, XE, XP, XS, XU, 24, 25, 27, 57, 58, 59, 78, 79, and 91. (View CPT® and HCPCS modifiers.)
Comments (2)
Posted By Melanie Witt on 10-26-2019, 14:59:16
I checked and there is no instructional note about these 2 procedures either in CPT or the CMS manual so how this bundle came to be I have no idea. In fact CPT instructs you to report a code from within the range of 57591 for microbial identification. So I would use an XU modifier on 57591 to get it paid as it it much more specific than -59.
Posted By Melanie Witt on 10-17-2019, 13:27:17
Great question for which I have no idea. I am at a conference teaching at the moment, but will investigate further tomorrow afternoon. At least a modifier is allowed to bypass the edit.
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