Forum - Questions & Answers

Apr 28th, 2016 - ent330w

Denied for Incidental

I am an ENT coder/biller and we have been denied for our last line item CPT® code 31240.

This is how it appears on the claim:

1. 30520
2. 30802-51
3. 31254-50-51
4. 31240-50-51---Denied for Incidental

In looking this up on Encoder Pro, I am showing that these codes do not have NCCI edit issues.

Can you tell me how to appeal (what documentation) you would suggest?

Thanks

Lori Sekora
ENT Associatates
406-238-6161
backoffice@entabillings.com

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Apr 29th, 2016 - LBAROGIANIS 250 

re: Denied for Incidental

My guess is because both 31254 and 31240 are nasal sinus endoscopy surgeries. I would appeal and clearly define where both sections are located and that you used mod 51 to show that this is a multiple procedure.

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