Wiki Appeals for 29823 with 29827.

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Pooler, GA
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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.
 
It seems to me that BX is behind the times. The very source that they state "excludes" 29823 from being billed with 29827 has in reality stated that 29823 can be billed with 29824, 29827 & 29828 since the 2017 update. In the most recent policy, 2020, this topic is covered on page 8. Code 29823 has not been bundled with 29824, 29827 or 29828 for the past four years and if any insurance claims to be following the NCCI surgical policy manuals, why are they then not following them?
 
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