- Messages
- 4
- Location
- Pooler, GA
Anyone having any luck appealing these codes with BCBS Anthem GA? I have sent the AAOS appeal letters and I am still getting denials. Documentation is correct.
This is their reasoning.
After review, it has been determined that the claim has processed correctly. The National Correct Coding Initiative Policy Manual for Medicare Services and the edits were developed for the purpose of encouraging consistent and correct coding and reducing inappropriate payment. The edits and policies do not include all possible combinations of correct coding edits or types of unbundling that exist. Providers are obligated to code correctly even if edits do not exist to prevent use of an inappropriate code combination. Therefore, the lack of a CCI edit between two procedures does not preclude including an edit in the default knowledge base and sourcing it as appropriate. Therefore, procedure 29823 is not recommended for separate reimbursement when submitted with procedure 29827.
This is their reasoning.
After review, it has been determined that the claim has processed correctly. The National Correct Coding Initiative Policy Manual for Medicare Services and the edits were developed for the purpose of encouraging consistent and correct coding and reducing inappropriate payment. The edits and policies do not include all possible combinations of correct coding edits or types of unbundling that exist. Providers are obligated to code correctly even if edits do not exist to prevent use of an inappropriate code combination. Therefore, the lack of a CCI edit between two procedures does not preclude including an edit in the default knowledge base and sourcing it as appropriate. Therefore, procedure 29823 is not recommended for separate reimbursement when submitted with procedure 29827.