Wiki Bundling Issues

[hbarney1]

I received a denial which they performed 29580 and 11042 which the letter (from BCBS) states that these code cannot be coded together. I double checked in the book and not seeing any issues with those codes being coded together. A modifier has already been appended on 29580. Is there any documentation stating other wise? Thanks.

 

[01289355]

Medicare,may not pay for both 11042 and 29580 when treating the same wound. but not all payers.

Check BCBS Availity portal

 

[espressoguy]

What modifier did you use?

Wound debridement includes wound dressing.

At it's simplest an unna boot (29580) or compression wrap (29581) is wound dressing. When I coded for podiatry/wound care we would use an XU or 59 modifier and the provider would add a sentence or two to justify medical necessity.

 

[meghanhannus]

Modal

Hello hbarney1,

For MCR if the debridement and Una boot were in the same location than only the debridement will be paid (check out the CMS NCCI Manual, in Chapter 4, Section G, paragraph 3: "Debridement CPT codes (e.g., 11042-11047, 97597) and grafting CPT codes (e.g., 15040-15776) should not be reported with a casting/splinting/strapping CPT code (e.g., 29445, 29580, 29581) for the same anatomic area." ). If the debridement and Una boot are not in the same location than you can bill/be reimbursed for both with modifier 59 on CPT 29580 since there is a NCCI edit and CPT 29580 is a column 2 edit. You should try to contact BCBS to see what their policy is maybe they follow the MCR guidelines.


M.Hannus, CPC, CPMA, CRC

 

[ypereira]

Hello hbarney1,

Effective April 16, 2018 HBCBSNJ will not longer reimburse CPT 29580 separately if performed with CPT codes 11000, 11010, 11011, 11012, 11042, 11045, 11043, 11046, 11044 and 11047.

Please refer to the link below for additional information. Hope that helps.

https://www.horizonblue.com/providers/news/news-legal-notices/medical-policy-update-unna-boot