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Wiki Advise

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rufus

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Need advise please!!! My physician is billing a 34201(Embolectomy) with a 35661(Bypass graft) my question is even though these don't hit a CCI edit are they considered bundled? I have received conflicting information on this. Any help is appreciated!!
 
i checked it in encoder pro and it was fine with 35661, 34201-51. it didn't say i was undbundling anything. the only thing it had was - "A multiple procedure reduction of 50% of the allowed amount may apply to this claim line."
 
Was the graft at the site of the embolectomy? While there is no CCI edit, which is what Encoder Pro is looking for, 34201 does specifically state in the notes that it includes the repair of the blood vessel. So if the graft was to repair the vessel at the site of the embolectomy, you should not code 35661.

Karen Hill, CPC, CPMA
 
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