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weird denial against NCCI edits

  1. #1
    Default weird denial against NCCI edits
    Medical Coding Books
    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. Default
    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
    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
    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.

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