• Revenue Cycle Management
  • COVID-19
  • Reimbursement
  • Diabetes Awareness Month
  • Risk Management
  • Patient Retention
  • Staffing
  • Medical Economics® 100th Anniversary
  • Coding and documentation
  • Business of Endocrinology
  • Telehealth
  • Physicians Financial News
  • Cybersecurity
  • Cardiovascular Clinical Consult
  • Locum Tenens, brought to you by LocumLife®
  • Weight Management
  • Business of Women's Health
  • Practice Efficiency
  • Finance and Wealth
  • EHRs
  • Remote Patient Monitoring
  • Sponsored Webinars
  • Medical Technology
  • Billing and collections
  • Acute Pain Management
  • Exclusive Content
  • Value-based Care
  • Business of Pediatrics
  • Concierge Medicine 2.0 by Castle Connolly Private Health Partners
  • Practice Growth
  • Concierge Medicine
  • Business of Cardiology
  • Implementing the Topcon Ocular Telehealth Platform
  • Malpractice
  • Influenza
  • Sexual Health
  • Chronic Conditions
  • Technology
  • Legal and Policy
  • Money
  • Opinion
  • Vaccines
  • Practice Management
  • Patient Relations
  • Careers

Q&A: When a claim is denied on the basis of "bundling"


Mutually exclusive code edits play a role in whether procedures can be bundled.

Q: Our surgery practice receives denials from insurers for procedures supposedly bundled together, yet when we check the current National Correct Coding Initiatives edits listing, we don't find the codes involved in the Column 1 or Column 2 edits. Is the insurer incorrect, or are we not looking at the correct resource?

A: A denial on the basis of "bundling" can originate in multiple places. Typically, the verbiage will read "this procedure is not separately reimbursable" or similar language. The first place to look is at the descriptions in the Current Procedural Terminology book. If the primary code descriptor includes other services (identified by CPT codes) and you are billing for the identified services, then no payment will be made. You indicated you have already checked the Column 1 and Column 2 edits, but you didn't indicate whether you checked the mutually exclusive code edits for bundled services. Mutually exclusive edits can be found at http://www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp.

Related Videos
© drsampsondavis.com
© drsampsondavis.com
© drsampsondavis.com
© drsampsondavis.com
Mike Bannon ©CSG Partners
Mike Bannon ©CSG Partners