Internal Medicine Coding Alert
Double-Check the NCCI Edits, Your Modifier Use
PDF
Question: When an insurance company denies a claim, stating a procedure is inclusive to the primary procedure, but it is not, what step can we take to easily and clearly show this? Answer: First, double-check the National Correct Coding Initiative (NCCI) edits to make sure Medicare doesn't bundle the procedures. Also, if you used modifiers, be sure you used them appropriately. For example, you can't attach modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to a procedure code.
Colorado Subscriber
If you correctly reported the services, your practice should formally appeal the denial. Provide the insurer with documentation, such as NCCI edits and pages from the CPT manual, that supports your claim. Get the insurer's response in writing for your records.
Internal Medicine Coding Alert
- Want to Keep Your Cerumen Removal Coding Out of Trouble?
How your practice can make $48 a pop on 69210 Don't let confusion over coding [...] - 6 Surefire Tips Get Your Cerumen Removal Claims Paid
Why you'll get denied if you report 69210 more than once per episode With numerous [...] - Condition of the Month:
Acute Chest Syndrome: Bone Up on Initial Exam, Diagnosis Coding
Signs-and-symptoms coding is key to solid claims Now that sickle-cell disease patients are living longer, [...] - You Be the Coder:
Choose Between 99313 and 99302
Question: A physician performs a history, evaluation and medical decision-making on a nursing facility patient [...] - Here's How to Earn Ironclad NPP Reimbursement
You can bring in an extra $35 for each 99202 claim Knowing whether to bill [...] - Reader Question:
Modifier -25 Is Not Required for 99291 Payment
Question: When billing for critical care visits, should I use different diagnosis codes for 99291 [...] - Reader Question:
Give V Codes Priority When Coding Pre-Ops
Question: What is the correct sequencing for the diagnoses associated with a preoperative exam?
Montana [...] - Reader Question:
Double-Check the NCCI Edits, Your Modifier Use
Question: When an insurance company denies a claim, stating a procedure is inclusive to the [...] - Reader Question:
Prove You Submit Timely Claims - or Else
Question: Although no law requires us to send claims or appeal by certified mail, insurance [...] - Reader Question:
Give the Flu Shot, Skip the Extra Office Visit
Question: A new patient came to the office just for a flu shot. Because the [...] - Reader Question:
Find Out What Separates 84153 From G0103
Question: Are 84153 and G0103 interchangeable for prostate specific antigen screening labs? The internists link [...] - Reader Question:
An E/M Code Works for Smoking Counseling
Question: Will Medicare insurers pay for smoking-cessation treatments? If so, what codes and documentation should [...]