Wiki Bundling issues regarding CPT 20610 and 64418

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ollielooya

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Hi specialists, and although I've had only one response from submitting a more detailed question to the general forum, thought I'd try this forum and ortho to see if there are any that know the answer. I know AAPC frowns on cross-coding posts, but really need some input to my question.

If these two codes (20610 and 64418) are billed together, NCCI edits indicate a bundling relationship--- a modifier can over-ride if appropriate. However both 20610 and 64418 were performed in the same area, so modifier 59 or XS is NOT appropriate. Dr. does not usually perform these two same procedures together as 64418 is performed for pain control and each code has it's own separate diagnosis code Therefore, MIGHT these two procedures be unbundled and if so, would XU be the appropriate modifier?

I'm Just trying to ascertain (from a general perspective as I do not yet have the notes) if there are cases when the procedures are performed in the same area with different dxsthat the edits COULD be overwritten.
 
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David, thank you for your reply. My post had received minimal response and still remains a matter unsolved. From an administrative viewpoint, it appears that it WILL bundle per CCI edits, but from a clinical perspective I was trying to get input as to the times it might be appropriate to bill separately. Our specialist did tell us he performs very few of these services together...
 
If you are going to do this then the XU would be the modifier. However you will need two different definitive dx for this to work. Not a diagnosis and a symptom, or two different symptoms. This will depend on the strength of the diagnosis codes and exceptional documentation, because I still see an appeal in the future.
 
I agree w/Deb
If the documentation supports 64418 and a bursa injection of the hip or knee then it would qualify for the modifier.
If 64418 and a bursa injection of the shoulder is done you should be looking for other anesthetics for the bursa. If you cannot find any then search the documentation for the results of 64418 to insure that it's not being done simply for the benefit of giving the bursa injection of the shoulder.
 
Peter and David, thank you for each of your responses as they were tremendously helpful. I apologize Peter for getting your name wrong. Another reason why I should stop working into the late night hours. Based upon my research and confirmed by your posts, I feel there is enough evidence to support our next move. Thank you both so much!
 
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