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Wiki Help--63047 & 63048
- Thread starter tfrancis
- Start date
Hi. One area I usually check is the NCCI edits to see if the codes can be billed together. I also check to see if there is a NCD or LCD under the Medicare coverage database on the subjects to see if certain ICD-9 and CPT codes are covered. In addition, you can check your carrier's website to see if they have published materials online that have been sent to your office in paper form that you may not have seen. Check CPT assistant as well.
RebeccaWoodward*
True Blue
Member 7 gives some good advice, however, many denials can be "over turned" by appeals and peer reviews. If your surgeon feels that his procedure was distinct and separate, I stongly encourage you to send a letter of appeal. Without giving too may details, United HealthCare would not pay for one of our spine surgeries based on unproven and experimental. I appealed this several times and ultimatley took this to the insurance commissioner. Needless to say, I won. Your surgeon deserves the right to be paid for their services