Part B Insider (Multispecialty) Coding Alert
Beware Carrier-specific Edits
Published on Sat Jun 28, 2003
It's important to be aware of new National Correct Coding Initiative edits so you can avoid billing codes together improperly, says Steve Verno, director of reimbursement with Emergency Medicine Specialists in Hollywood, Fla. But you also need to know these edits by heart if you appeal carrier denials for inclusive or mutually exclusive codes.
Unfortunately, some carriers use their own internal edits instead of, or in addition to, the NCCI Edits , Verno says. These may be "based on personal opinion rather than published doctrine," and knowing the NCCI edits won't help you in these cases. Your appeals will have to go past the carrier level to obtain any relief, he says.
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