Wiki incidental to the primary procedure?

[antimolinergic@gmail.com]

Hi Can someone enlightened me please with this denial. "Revenue code is incidental to the primary procedure". The OR or Treatment room code with the items is incidental to the primary procedure. Is there a transmital, OEM or any CMS documentation about this or is this just a internal policy of insurances. Can you also post link so I can use them when I appeal a denial. Much thanks

 

[thomas7331]

This does not sound like a denial to me, but you would need to know the payer and the particular reimbursement methodology to know for sure. Many outpatient facility claims involving surgical procedures are paid at case rates based on the procedure performed, and all of the incidental services (e.g. anesthesia, drugs, supplies) will be inclusive in that case rate. The first thing you would need to do is review your facility's payer contract rate or Medicare APC for the procedure to find out if that was paid in full on another claim line. If so, then there is no separate payment due for the revenue code that you are seeing with this 'denial' explanation. If, however, your contract shows that you should be receiving a separate payment for this line item, then you'll need to consider whether a modifier may be appropriate, or appeal with documentation from your contract to show that the claim was paid incorrectly.

 

[antimolinergic@gmail.com]

Thank you sir for the reply.