Insurance carrier is denying charges stating they are bundled

mlwinet

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I am in the process of doing an appeal for an in-patient facility claim. The insurance carrier is denying 2 of the charges stating that they are bundled. When I looked up the codes in NCCI edits they are allowed to be billed separately, but it appears that the NCCI edits is related to OP services/claims. Since this is an In-patient facility claim where can I go to confirm whether or not these 2 charges are bundled or can be billed separately.
 

thomas7331

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You're correct NCCI rules do not apply to inpatient facility charges. Inpatient claims are not usually paid based on charges submitted but rather based on the diagnosis codes and length of stay, and paid at DRG or per diem case rates. Your denied charges may be part of those case rates, but in order to know if the denial was appropriate or not, you'd need to look at how the inpatient claim was paid and whether or not it was paid in full under the terms of your contract with the payer or under the Medicare or Medicaid payment guidelines, whichever the case may be.
 

mitchellde

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NCCI does not even contain the ICD-10 PCS codes so I am wondering how that edit even got kicked in the system? You said it was the facility claim so they would be using the PCS codes. How curious!
 

CodingKing

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NCCI does not even contain the ICD-10 PCS codes so I am wondering how that edit even got kicked in the system? You said it was the facility claim so they would be using the PCS codes. How curious!

DRG goes off DX so i''m still comletrely loss of What PCS is even used for. However CPT and HCPCS codes are still used on inpatient claims so it woudlnt be a denial based off PCS
 
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