Coding and payment

NCCI edits: billing for pulmonary function tests and consultations on the same day

The national correct coding initiative (NCCI) had published an edit in early 2014 which stated that consultation codes were included in pulmonary function test billing codes. The Advocacy Council called this error to the attention of NCCI and they withdrew the recommendation - effective January 1, 2014. The withdrawal has been recognized by all carriers except one. The Advocacy Council is working to convince the single carrier that NCCI did withdraw this recommendation. If you continue to experience problems, please let the Advocacy Council know; we don’t need records on this. We hope you understand that we continue to work on your behalf to get this straightened out; however, we have not been successful…yet.

Preauthorization for treatments or testing

When new processes or tests are introduced, carriers frequently deny payment because they are not familiar with the test or with the treatment. This is best exemplified by denials from more than a few carriers to cover RUSH/cluster immunotherapy.

The Advocacy Council recently received a question from a member asking how to code for a workup of a patient who gave a history of food related exercise-induced anaphylaxis. The workup included an exercise test on a track located at the campus of the local hospital. Our advice for these situations is to contact the carrier and get prior approval for the proposed test or treatment. Ask the carrier to provide a written response which includes approval of the test/treatment, which codes to use for billing and how much to charge. This approach has been successful in a number of situations when the Advocacy Council has provided this advice. If there is a problem with approval of the test or treatment, this approach will allow you the chance to argue your case before providing the test/treatment. If you have questions as to whether to use the prior approval route, please contact advocacycouncil@acaai.org.