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CCI Edits Denial

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PippiT:
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:
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.

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