CatchTheWind
Guest
If procedure B is bundled with procedure A, but has a higher allowance than procedure A, can you bill for just procedure B?
For example, skin biopsy (which has a Medicare allowance of $108.65 in our locality) bundles into destruction of pre-malignant lesion, even though the allowance for destruction is only $79.73. So if the provider does a biopsy, then goes ahead and destroys the lesion in the same session, and the biopsy comes back pre-malignant, billing for both procedures will result in the biopsy code being denied. Can we bill for just the biopsy?
Second example: Intermediate repair of excision of benign lesions 0.5 cm. or smaller is bundled into the excision. Since the excision has a lower allowance than the repair, can we bill for just the repair?
For example, skin biopsy (which has a Medicare allowance of $108.65 in our locality) bundles into destruction of pre-malignant lesion, even though the allowance for destruction is only $79.73. So if the provider does a biopsy, then goes ahead and destroys the lesion in the same session, and the biopsy comes back pre-malignant, billing for both procedures will result in the biopsy code being denied. Can we bill for just the biopsy?
Second example: Intermediate repair of excision of benign lesions 0.5 cm. or smaller is bundled into the excision. Since the excision has a lower allowance than the repair, can we bill for just the repair?