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Tuesday, June 22, 2010

Insurance denial - INAPPROPRIATE BUNDLING OF SERVICES

"INAPPROPRIATE BUNDLING OF SERVICES"

Description:

This indicates a lack of awareness of the National Correct Coding Initiative Edits (NCCI) that govern appropriateness of tests being performed together on the same date of service. Alternately, it may indicate a lack of understanding of the appropriate code status of a specific CPT code. For example, payment for "B" status code services is always bundled into payment for other services, whereas with "C" status codes, the local carrier determines bundling and the appropriateness of the procedure and subsequent reimbursement.

Action:

Access the NCCI Edits on the Medicare Web site (http://www.cms.hhs.gov/NationalCorrectCodInitEd/) to review which codes can and cannot be billed together on the same date of service, as well as the appropriate modifiers to use in those situations. Also, familiarize yourself with the status code of the CPT procedure code you work with. These change at minimum on a quarterly basis.

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