Wiki Coding GI procedures that are bundled

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1formissy

1formissy

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There is some discrepency in my environment when it comes to coding GI procedures when there are bundling edits involved.
I need some help from some of you GI coders, please.
It's my understanding, and always has been, that whenever GI CPT codes are considered bundled, (NCCI edits), and the documentation supports the services, you would initally append a overriding modifier (59) on the second CPT code. Which would have a lower RVU than the primary CPT code.
However, I am now told, (after all these years) that it is not true, if you have a primary CPT code, and it is bundled with another code on the same claim, you would put a modifier 59 on the primary code.
Honestly, never heard of that! Could someone shed some light on this for me? I have someone telling me that everything I have taught her is wrong.
 
bundling issues

You Can't just go by the Dollar amount value - Review the CCI edits and if it is a column two code that is the code that is applied the "59" or appropriate modifier -We are having an issue where Dilation and biopsies are being denied as "Rebundling" heard of that one?
 
We no longer use 59 for most procedure. We use the new modifier XS and document the area of where the separate sites are. But you would put the modifier on what is listed under the 2nd column.
 
I know about the new modiifers, I use them daily. I found out the person that told the physician that I was wrong, was wrong herself. This has been resolved, thank you everyone for your imput.
 
dilation & biopsies bundling

We too are having a HUGE issue with the biopsies bundling with dilation! The payer (which is one of our largest carriers in our area) is quoting a variety of resources from CPT & CMS that don't specifically address the 43239 with 43249 but also includes this statement:
''If a biopsy is performed and submitted for pathologic evaluation that will be completed after the more extensive procedure is performed, the biopsy is not separately reportable with the more extensive procedure.''
They are considering the dilation the more extensive procedure.

jojolynn said:
You Can't just go by the Dollar amount value - Review the CCI edits and if it is a column two code that is the code that is applied the "59" or appropriate modifier -We are having an issue where Dilation and biopsies are being denied as "Rebundling" heard of that one?
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