Wiki Appeal Tip of the Week 5/14

Bradenton, FL
Best answers
Not Paid Separately...It's More Than NCCI

Mutliple services on the same date don't only deny due to NCCI edits. There are many procedures which by definition should not be paid in addition the primary service on any given date. CPT codes with a "separate procedure" designation may only be paid with other services under certain circumstances regardless of NCCI. Services such as lysis of adhesions are considered to be integral to the primary surgical procedure when done to access the operative field.

In the absence of NCCI edits there may be other reasons such as the ones listed above that some of your services are being denied as "not separately payable".

Do your homework before sending in second level appeals. Look past NCCI edits to see if there are other AMA/CPT coding/documentation guidelines impacting your coding combinations.

The best appeal is one that is valid and will hopefully end in a reconsideration.