Wiki Bundling issue

Create Wiki
A

aekenyon87

Contributor
Messages
10
Best answers
0
Patient came into the ER and had I&D performed (10080). Patient came back to ER two days later as the abscess was getting worse and second I&D (10080) was performed. The insurance is now denying the second 10080 as bundling and I know this CPT has 10 day global period. The second E&M visit was paid, but can we be billing the second 10080 due to the global period?

Thanks!
 
devinmajor14 said:
Try adding modifier 78 to 10080 to unbundle it.
Click to expand...

You should not "try" modifiers - modifiers must be used only when supported by the medical records. If this procedure was done in the ER, I don't believe modifier 78 would be supported - the ER is not an operating room.

You might be able to use a modifier 58 if the documentation supports it. But without a return to the OR, a related procedure is inclusive to the global surgical package under most payer policies.
 
Medicare Denial 236, for office vist

Medicare Denial 236, for office vist
Hello,

I work for an Urgent care having trouble getting my office visit paid 99201 with Medicare. Medicare paid for the IMMUNIZATION ADMIN and TDAP Vaccine but not he office visit. Can someone please help. Thank you
 
An E&M with an immunization is typically bundled. Unless the E&M supports a separately identifiable issue, you can only bill the immunizaiton/administration. If the documentation supports something other than the need for the Tdap, then add the -25, but make sure your documentation is solid.
 
You must log in or register to reply here.
Top