Cardiology Coding Alert
Understand Difference Between Claim Denials Versus Rejection
Question: I filed a claim, and it was rejected. When I reviewed the claim, I discovered the National Provider Identifier (NPI) number was incorrect and fixed the error. Should I now appeal the claim? Pennsylvania Subscriber Answer: You cannot appeal a claim that was never technically filed. Because of the error with the billing provider’s NPI, the payer rejected the claim. This is not the same as a denial. A claim rejection occurs before the claim is even processed, meaning it was never filed. You can only appeal once the payer denies the claim, meaning the payer tells you they won’t pay after accepting the filing. This may be due to terms of the patient-payer contract, incorrect procedure or diagnosis codes, or other reasons the payer notes during processing. When you receive a rejection, you need to fix the errors and resubmit the claim with the corrected information. This is not an appeal, as explained. If the claim is denied at that point, you can appeal if warranted.
Related Articles
Cardiology Coding Alert
- CPT®:
Navigate Tricky Holter Monitoring Claims With Ease
Hint: Knowing the length of monitoring time is crucial. Sometimes your cardiologist may perform Holter [...] - ICD-10-CM:
Answer 7 FAQs About Cardiomyopathy to Ace Your Claims
Remember: Report I42.0 for dilated cardiomyopathy. If your cardiologist treats cardiomyopathy, an enlargement or thickening [...] - Denials:
Avoid Denials in Your Practice With Expert Tips
Hint: Educate your staff. Working in healthcare, you already have a lot on your plate, [...] - You Be the Coder:
Puzzle Out This Pulse Generator Removal Situation
Question: My provider made an incision on the patient’s skin over the subcutaneous pocket, enclosing [...] - Reader Questions:
Understand Difference Between Claim Denials Versus Rejection
Question: I filed a claim, and it was rejected. When I reviewed the claim, I [...] - Reader Questions:
Pinpoint Correct Codes for ICD Removal
Question: My provider removed an existing implantable cardioverter-defibrillator (ICD) from the pocket. They removed one [...] - Reader Questions:
Remember, MDM is Crucial
Question: Suppose a physician orders a diagnostic test, such as an electrocardiogram (EKG), but the [...] - Reader Questions:
Follow Advice to Timely Claims
Question: How do I know if a medical record is completed in a “timely” manner? [...] - Reader Questions:
Solve Cardioversion Conundrum
Question: The patient was put in the supine position with their chest exposed, and my [...]
