The National Correct Coding Initiative Lookup Tool
The National Correct Coding Initiative Lookup Tool is designed to help providers identify when certain codes are subject to the automated code pair edits. Search for coding pairs by entering a procedure code and the performing date(s) of service. The search results display two coding pair lists; refer to the Major-to-Minor and the Minor-to-Major tabs.
When two codes of an edit pair are identified, the major/column 1 code is eligible for payment and the minor/column 2 code is denied with CARC C0236. However, both codes may be eligible for payment when the modifier/policy indicator 1 (allowed) is present and an appropriate modifier is appended to the minor/column 2 code on the claim.
Column 1 and Column 2 Codes
- Column 1 Major Code: This is the primary service code that Medicare considers for reimbursement.
- Column 2 Minor Code: This code represents a service that is typically included in the primary service (Column 1) and is generally not separately reimbursed when reported together.
Modifier/Policy Indicator Codes
Understanding the Modifier/Policy Indicator helps you determine if it's appropriate to use a modifier to report both services.
- Indicator 0: Modifiers are not allowed; codes should not be billed together.
- Indicator 1: An appropriate modifier may be used to override the edit if the clinical scenario justifies it.
- Indicator 9: Not applicable. The code pair is no longer bundled, no modifier is needed for purposes of noting an NCCI exception.
Common modifiers include:
- Modifier 59: Indicates a distinct procedural service.
- Modifiers XE, XP, XS, XU: Subsets of Modifier 59, providing more specific scenarios.
Use Modifier 59 and the Subset Modifiers XE, XP, XS, XU – Specific Modifiers for Distinct Procedural Services modifiers carefully and make sure the documentation justifies their use.
NCCI Lookup Tool Example
If you see a pair like 99215 (Column 1) and 0469T (Column 2), it indicates that 0469T is considered part of the service described by 99215 and should not be billed separately. The Modifier/Policy Indicator Code of 0 indicates modifiers are not allowed, these codes should not be billed together.
Posted 3/3/2025