Don’t Get Bungled Up by Bundled Codes

At first listen, “bundling” codes sounds like a nice thing to do. After all, “bundling up” keeps you warm when it’s cold out and making “a bundle of money” is always a welcome development.

In a practical sense, if bill codes are bundled together, there are fewer – right? Which would mean less work to do… which tends to be a positive thing around a busy office.

So is the bundling of CPT codes a friendly gesture on the part of a payer? Not always. In the best instances, bundled codes cut down on paperwork and ensure proper payments. But in less fortunate cases, they also cut down on reimbursements.

What is Bundling?
When a payer bundles codes, it combines two or more codes into one. Doing so allows them to replace two codes with one overarching code and pay the provider only for the amount allowed under the more dominant code.

“Bundling can cut down on your receivables,” says Michele Redmond of Solutions Medical Billing, “Because by bundling the codes together they are only allowing the fee schedule allowance for the one code that they feel is appropriate.”

Of course, bundling is only allowable because in many instances, it’s the accurate means for coding an encounter. If there’s one bundled, “major” procedure code existing that encompasses two or more procedures that took place in the same encounter, it’s only proper to use the more significant, inclusive code.

To Bundle? Or Unbundle?
For example, if a patient comes to your office with a nosebleed and the physician performs a diagnostic nasal endoscopy (31231), you wouldn’t code the claim for both the cautery of the nosebleed (30903) and the endoscopy, since handling and eliminating the bleeding is a given part of the endoscopy procedure.

The problems arise when commonly bundled procedures are performed separately. Let’s say, using the examples above, that the physician first performed the nasal endoscopy during a 9 a.m. appointment. At 2 p.m., the patient shows back up with a nosebleed and requires treatment. What then?

In instances like that, you can (and should) add a modifier – namely modifier 59 for “distinct procedural service” – to the cauterization code and put both codes on your claim. Using 59 is the only way to “unbundle,” which indicates to the payer that the two procedures were performed separately and the physician should be reimbursed for both of them.

Modifier Neglect
Yet coders frequently forget to add such appropriate modifiers to their CPT codes in instances like the one above. They put both 31231 and 30903 on the claim, leaving out 59, so the payer bundles the services and reimburses only for the higher procedure.

On other occasions, the payer ignores the modifier, thinking it was added inappropriately in the provider’s effort to get a larger reimbursement than deserved. Overlooking the modifier that way is unacceptable, but it often goes unnoticed.

Billing departments who fail to thoroughly review their EOBs will miss this underpayment error every time, so bundling is one of many reasons why it’s critical to evaluate all EOBs upon receipt.

Where to Turn
But even those billers that do give all EOBs a solid assessment can miss inappropriate bundling if they aren’t current on the latest medical coding updates. All coders should have a thorough understanding of coding methodologies – as well as a good grasp of what resources they should review to verify that bundled codes were used properly.

The National Correct Coding Initiative (NCCI) was established by the Centers for Medicare and Medicaid Services (CMS) in 1996 “to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims.”

The rules outlined in the NCCI Coding Policy Manual, the CMS’ coding reference tool, apply specifically to Medicare claims but are also useful in assessing non-Medicare claims, since coding rules are fairly standardized across all payers. The manual is the best place to turn with bundling questions and concerns.

If you’re still questioning a code bundle after reviewing it, turn specifically to the resources of the payer you’re dealing with.

If you learn that you’re the victim of underpayment die to improper bundling, fix your coding, appeal your claim, and don’t stop fighting until you get the payment you’re due. Then, arm yourself against future underpayments by staying current on always-changing coding rules and NCCI edits.

Don’t let bundling get the best of you.

How have you dealt with code bundling issues at your practice?

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