| What exactly is "bundling" anyway? It is when an | | | | EOBs can be fairly complicated and it is important to |
| insurance carrier combines two or more CPT codes, | | | | understand what the insurance company did with the |
| substituting one overarching code, often ignoring | | | | claim. |
| modifiers along the way. This practice can cut down | | | | When the claim is processed and you receive the |
| on your receivables. When codes are bundled, the | | | | EOB you need to make sure the insurance company |
| codes are grouped together and the insurance carrier | | | | allowed both codes separately. After all, you did an |
| will only allow the fee schedule allowance for the one | | | | office visit to manage to high blood pressure and you |
| code that they feel is appropriate. | | | | did the aspiration which was completely separate |
| There are ways to get around bundling. First you | | | | from the office visit. |
| need to make sure you are billing the claim properly | | | | If the insurance carrier bundles your codes you |
| on the initial submission. For example, if you are billing | | | | should file an appeal. In many cases the insurance |
| for an E&M code for a patient who comes in | | | | carrier will reprocess the claim and unbundled the |
| with high blood pressure but the patient is also | | | | codes if you go through the appeal process. |
| complaining of knee pain and you end up doing an | | | | The appeal does not have to be complicated. It can |
| aspiration of the knee joint, then you need to make | | | | be a form letter that you design where you just |
| sure you use the correct modifiers to indicate what | | | | need to fill in the blanks. A lot of carriers bundle the |
| you are doing. You want to bill the E&M code, | | | | claims on initial processing because the majority of |
| say it is a 99213, with a 25 modifier to indicate that it | | | | offices will not appeal the claim. Just think how much |
| is a separate and distinct service provided during the | | | | money they save! |
| same visit. Then you would bill for the aspiration of | | | | You may think that it's not worth the time to appeal |
| the knee joint with the appropriate code using a 59 | | | | but you may be surprised if you knew how much |
| modifier to indicate a distinct procedural service. | | | | money you actually lost over time. If you have a |
| It is quite necessary to know the proper use of all | | | | system in place to file the appeals that is a fairly |
| the different modifiers to get full reimbursement for | | | | simple process it won't take much time and you can |
| your services. Also as important is the ability to read | | | | increase your receivables. In my opinion, it is worth |
| an EOB (explanation of benefits statement) correctly. | | | | the effort. |