Blue Choice Carefirst denied a PTP edit CPT 11721-59 when billed with CPT 11056 with a denial reason code of “ccy”, I have never heard of this edit do you know what it is? I looked on their website and can’ find this anywhere! So, the we did some digging into this It turns out the EOB stated “ccy” and on the EOB=Provider must submit a valid modifier procedure code combination, really?
Can a private payer make up it’s own coding initiative, we have seen McKesson products over the years which incorporates NCCI but adds more is this that? Reaching out to this doctor, the representative stated they use NCCI to determine the denial!
Clearly, the code pair should be billed with a “59” on CPT 11721 as it is a column 2 code to CPT 11056 but are they looking for the “XS”? Hopefully, more information will be gleaned from this issue, stay tuned!
Blue Choice Carefirst denied a PTP edit CPT 11721-59 when billed with CPT 11056 with a denial reason code of “ccy”, I have never heard of this edit do you know what it is? I looked on their website and can’ find this anywhere! So, the we did some digging into this It turns out the EOB stated “ccy” and on the EOB=Provider must submit a valid modifier procedure code combination, really?
If the entity is a HIPAA covered entity it should deny using the typical codes we see that start with "CO’ or “N” or “PR” are some that common ones that come to mind right away. Looking on the Carefirst BCBS site and their billing requirements this is what was found: https://provider.carefirst.com/carefirst-resources/provider/pdf/provider-manual-chapter-5-claims-billing-and-payments.pdf
Can a private payer make up it’s own coding initiative, we have seen McKesson products over the years which incorporates NCCI but adds more is this that? Reaching out to this doctor, the representative stated they use NCCI to determine the denial!
Clearly, the code pair should be billed with a “59” on CPT 11721 as it is a column 2 code to CPT 11056 but are they looking for the “XS”? Hopefully, more information will be gleaned from this issue, stay tuned!