AAPC - Back to school
Results 1 to 4 of 4

Thread: weird denial against NCCI edits

  1. #1
    Join Date
    Apr 2007
    Richmond, IN

    Default weird denial against NCCI edits

    AAPC: Back to School
    Looking for suggestions on how to fight this claim denial:

    Carpal tunnel surgery code 64721 was reported by the surgeon.
    we reported correct crossover code 01810 for our anesthesiologist with AA modifier.

    UHC denied our anesthesia claim stating NCCI edit to 64721!

    We have submitted 2 appeals and talked to the insurance reps twice. Both times being very difficult and saying to resubmit the claim for reprocessing with modifier and unable to help further.

    Are there any suggestions on how to approach this? I continue to appeal and they continue to deny for the same reason.

    If this was true, wouldn't all anesthesia be NCCI edit to the surgeon's bill!?!

    Very frustrated
    All suggestions are appreciated!

    Thank you!
    ~Melissa, CPC

  2. #2


    Have you contacted your Provider Rep with UHC. They usually have a specialized team that will work directly with you until the problem is solved.

  3. #3
    Join Date
    Apr 2007

    Default re:weird denial

    Are you using the AA modifier because UHC is a Medicare replacement insurance? We only use the AA if it is a Medicare claim and MAC is used. Otherwise just the 01810 and 354.0. I hope this helps.

  4. #4
    Join Date
    Apr 2007


    Might want to run a report and find other UHC claims that were they paid for the anesthesia and didn't erroneously bundled into the surgery code performed by a different provider. Provide the examples of the other paid claims and ask what makes this claim different.

Similar Threads

  1. NCCI edits
    By ojustus in forum Billing/Reimbursement
    Replies: 0
    Last Post: 04-11-2014, 03:37 PM
  2. NCCI Edits
    By CPalmer in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 07-14-2012, 08:42 PM
  3. NCCI edits vs Mutually exclusive edits
    By uhlerclarem in forum Medicare Regulations
    Replies: 1
    Last Post: 10-27-2010, 05:33 PM
  4. ncci edits
    By lshafer in forum Urology
    Replies: 1
    Last Post: 04-15-2010, 12:56 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.