Wiki Unbundled charges

[mowalker]

We are currently using Encoder Pro to help us determine if a code is a bundled procedure but some codes are listed as expectable to bill with a modifier.

Example is 24305-51 was paid by Pacificare but the 64718 was not.

Is there a reference book out there that would help us define better what is bundled and what is not?

Also, was that paid correctly?

 

[dmaec]

The CCI Edits will help you - link below:
http://www.cms.hhs.gov/NationalCorrectCodInitEd/

Also, the modifier would go on the 64718 (not the 24305) -

 

[Lisa Bledsoe]

We are currently using Encoder Pro to help us determine if a code is a bundled procedure but some codes are listed as expectable to bill with a modifier.

Example is 24305-51 was paid by Pacificare but the 64718 was not.

Is there a reference book out there that would help us define better what is bundled and what is not?

Also, was that paid correctly?

Do you have the Orthopedics Global Service Data books? They are expensive but from what I recall contained information about bundled procedures.

 

[KJ21]

we also use orthopaedics comprehensive guide for Upper spine and above and for Lower Hips and below.

 

[FTessaBartels]

Modifier due to two arms

The reason the modifier would be allowed is that you have two arms. So, one procedure could be performed on the left; the other procedure on the right. But if you are talking about surgery on only one arm, then 64718 is considered bundled into 24305.

Since you added the -51 modifer on 24305 in error, double check that your reimbursement is what it should be.

F Tessa Bartels, CPC