Wiki Medicaid Claim

[knperry]

I billed a surgery coded 27301, 11043, 97605. The primary code was paid and the other two denied incidental to another proc billed. Is this worth appealing and if so what would I need to send in with the appeal, a letter from the doctor stating that all were necessary.

 

[dclark7]

According to the NCCI edits these codes are incidental to 27301. There is a modifier indicator of "1" so a modifier is allowed, but the documentation needs to be really clear that they were separately identifiable procedures, if not 27301 is the only code you can use.

 

[knperry]

Thanks Doreen is there a link to the NCCI changes you can provide?

 

[dclark7]

Just to the the CMS website under Medicare, then coding and click on NCCI edits. http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html