apoland
New
Hello,
Our ASC has just opened up to do combo cases with an outside provider. They are doing their own professional charges and we are billing our providers professional charge and the ASC charge. For Medicare/Government plans, we are running into bundling issues between the codes our provider is doing and the outside provider. For example, the outside provider is performing a lumpectomy (19301-LT) and then our provider is going in and doing an oncoplastic reduction and contralateral breast (19318-50) reduction. Our ASC claim was billed with both providers, each provider, and XP modifier: 19318-XS 2 units, 19301-XP 1 unit. Medicare has denied bundled and is only paying for 19301, although its the column 2 code. Is this correct? Should we be billing differently? Any thoughts/guidance are very much welcome.
Thank you!
Our ASC has just opened up to do combo cases with an outside provider. They are doing their own professional charges and we are billing our providers professional charge and the ASC charge. For Medicare/Government plans, we are running into bundling issues between the codes our provider is doing and the outside provider. For example, the outside provider is performing a lumpectomy (19301-LT) and then our provider is going in and doing an oncoplastic reduction and contralateral breast (19318-50) reduction. Our ASC claim was billed with both providers, each provider, and XP modifier: 19318-XS 2 units, 19301-XP 1 unit. Medicare has denied bundled and is only paying for 19301, although its the column 2 code. Is this correct? Should we be billing differently? Any thoughts/guidance are very much welcome.
Thank you!