Medical Billing Forum
General Category => General Questions => : PippiT February 15, 2017, 12:56:59 PM
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Good morning!
We bill L4360 & L4396 quite frequently. We received a denial that L4396 is considered to be CCI Inclusive of procedure code L4360. (The modifier for both codes is LT). I have searched and searched and cannot find this CCI edit (never mind the fact the CCI site confuses me, but I have given a fair amount of time and effort searching). I called provider relations and they couldn't point to the edit and said I would have to appeal.
No other insurance company has denied either code in this way. I'm at a loss. One is a walking boot, one is a night splint. I am not even sure what write in my appeal. Any advice? Thanks in advance!!
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Since no other insurance carrier ha denied it sounds like an internal issue. I would appeal stating that L4360 is a walking boot and L4396 is a night splint. Explain (although it seems obvious) why the patient would need each one and that they are completely independent of each other. That is all you should need.