Sometimes, a line item on a claim is denied by the insurance company as "incidental to" another procedure. When you check the NCCI edits, you don't find that these are bundled by NCCI. What does this mean?
The insurance carrier is using their own edits in determining bundling. They are not using the NCCI edits. When they use the NCCI edits, the denial is "bundled" or a "component code."
If you find this, it rarely works to appeal individual claims. It will take re-negotiation at contracting to fix this problem. The AMA has an advocacy group that would like to hear about these types of payer policies.
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