An orthopedic clinic encoder flags an NCCI PTP edit. The edit’s mod…

Question

An orthopedic clinic encoder flags an NCCI PTP edit. The edit’s modifier indicator is “0,” and the surgeon asks whether modifier 59 will allow both codes. What is the correct coding response?

Accepted Answer

Do not append a modifier to bypass the edit; indicator “0” means a modifier cannot override the PTP edit. — Modifier indicator “0” is a hard stop—no key will open that lock. Indicator “1” is the door that might open if the note really shows a distinct service. Do not slap on 59 hoping the claim skates through.

Answer

Always append modifier 59 when any NCCI edit appears, regardless of the indicator.

Answer

Change the indicator in the practice encoder so both codes will pass.

Answer

Bill both codes without a modifier and rely on the payer to sort the edit.

An orthopedic clinic encoder flags an NCCI PTP edit. The edit’s modifier indicator is “0,” and the surgeon asks whether modifier 59 will allow both codes. What is the correct coding response?

Short Explanation

Full Explanation