Understanding NCCI Edits

Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for …

Q/A: I am Having Trouble with a Claim Rejection on my PI Claim. What do I do?

Question:

I have a patient that was involved in a PI case. His lawyers are asking that we bill his insurance company first. This particular patient has xxxx insurance and the clearing house is rejecting the claim based on “ERROR 3430-Invalid principal diagnosis code.” We lead with diagnosis code V43.52XA, could we change the position of the V43.52XA code? Or should we submit a paper claim for the case instead?

Q/A: Why is Code 99080 Being Denied when Billed with an E/M Service?

In order to understand and answer the question, “Why code 99080 is being denied when billed with an E/M Service, it is important to first review the requriements of selecting the appropriate level of Evaluation and Management service and how that relates to reporting a 99080 special report service. Continue reading for better understanding.

Can They Deny Electrical Stimulation by Saying There is no Evidence that it Works?

Topic: Electrical Stimulation (EMS)

Question: An orthopedic surgeon/IME recommended a denial for all electrical stimulation
(EMS) by stating that “according ODG electrical stimulation is experimental therefore not
medically necessary or eligible for reimbursement.” Is that true?

Results of an Audit: a Case Study

Here at ChiroCode we often get to look at doctor records and provide advice on ways to improve them. One of the main issues is lack of functional progress to establish medical necessity. That may sound like a mouthful, but it is not hard to make sure it is clear in a typical note. Learn about an actual case that was documented well, but still had room for improvement.