Author Topic: CCI Edits Denial  (Read 482 times)

PippiT

  • Newbie
  • *
  • Posts: 19
CCI Edits Denial
« on: February 15, 2017, 09:56:59 AM »
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!!

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4707
    • Solutions Medical Billing
Re: CCI Edits Denial
« Reply #1 on: February 16, 2017, 09:04:45 AM »
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.
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com