CPT Bundling (California)

This forum is dedicated to claims adjusters and the peculiar issues confronting claims professionals.

CPT Bundling (California)

Postby dpaige on Thu Nov 19, 2009 11:01 am

I am a coder/biller in an occupational clinic and have a question about bundling when it comes to surgery coding. It seems some carriers follow CCI guidelines or some kind of editing program, but a few others will pay for anything submitted regardless if the codes are bundled. So how do most coders/billers bill workers comp? Do you tend to follow bundling guidelines or just code for everything? I have to admit, being a certified coder, its hard just to code without taking bundling into consideration.
dpaige
 
Posts: 3
Joined: Thu Nov 19, 2009 10:34 am

Re: CPT Bundling (California)

Postby djohnson558 on Fri Dec 04, 2009 9:19 pm

Isn't it the norm to code everything separately? I'm a W/C collector for all of the Dr's in a major institution in So Ca. I thought coders usually coded by individual codes for W/C??
djohnson558
 
Posts: 7
Joined: Fri Dec 04, 2009 9:09 pm

Re: CPT Bundling (California)

Postby dpaige on Fri Dec 04, 2009 11:21 pm

I believe its just the opposite. As a certified coder we are bound to coding by the rules, and to deliberatly unbundle procedures to possibly maximize payment just goes against our training. That being said, it seems when claims are unbundled, based on the denials that I've seen, that the majority of the carriers do use some kind of editing program that will not allow payment for procedures that are considered a component of others. In contrast, private payment systems for the most part are very transparent. You can go to their websites and get their payment and policy guidelines. Workers comp on the other hand is very much hit and miss. Some carriers bundle, some don't. Some pay the second procedure at 50%, some pay at 10%. Just no real consistency. I've also seen incorrectly coded procedures that had nothing to do with the accepted condition that were paid. With workers comp it seems the overall train of thought is to bill for everything because depending on who's desk it lands on, things get paid that really shouldn't only because the claim reviewer doesn't know any better. So to think that its the norm to intentially unbundle procedures because workers comp will pay for everything, throw it at the wall and see what sticks...well it just makes me think that this system needs to get on board with the rest of the world and monitor themselves before its too late.

So to get back to your question about coding for workers comp, its the same as any other carrier. I read the op notes, abstract out the codes, then run them by the CCI edits, which could easily make a procedure that consists of 5 codes end up being billed out with only 2. So you either overcode (and I think risk getting audited) and inflate your A/R, or code right and keep things simple.
dpaige
 
Posts: 3
Joined: Thu Nov 19, 2009 10:34 am

Re: CPT Bundling (California)

Postby rider001 on Sat Dec 05, 2009 10:54 am

In some instances you are doing yourself a disservice by throwing everything at the wall. If you bill for a code that is bundled and wouldn't normally pay that code might be bundled with another that would normally pay. So the system rejects both codes as bundled even though they paid on neither codes. Unless the systems have become smarter in the last couple of years this was one of the problems i ran into when our sugery biller billed everything. I would end up having to appeal twice. Once to get rejected and again to get it it elevated to a nurse reviewer.
rider001
 
Posts: 151
Joined: Tue Mar 10, 2009 10:20 am

Re: CPT Bundling (California)

Postby wcscout on Mon Jun 06, 2011 3:02 pm

As always, pardon the ignorance, but what does it mean to "unbundle?"
wcscout
 
Posts: 273
Joined: Tue Mar 29, 2011 1:52 pm

Re: CPT Bundling (California)

Postby rider001 on Tue Jun 07, 2011 11:29 am

For example. When a patient attends an office visit and the provider writes a prescription. The writing of the prescription might have a fee associated with it but when the prescription is written at the same time as the office visit the prescription fee is bundle into the fee for the office visit. Antoher example is surgery. When a provider make an incision they could charge for that but it is considered integral to the surgery and that fee would be bundled in say the rotator cuff repair. So instead of charging for every sub-procedure those charges are included in the main procedure.
rider001
 
Posts: 151
Joined: Tue Mar 10, 2009 10:20 am


Return to Claims Adjusters

Who is online

Users browsing this forum: No registered users and 2 guests