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Wiki Need to unbundle procedures

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caue5224

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Issue:

Have a new patient with the following codes:

99203 modifier 25
11100 biopsy
10040 modifier 51

11100 and 10040 are distinct procedures but the insurance company bundled both hence did not pay for the biopsy.
What do I do to 11100 and 10040 to show that they are distinct?

Thank you!
 
They are not bundled according to the NCCI edits. This is a unique carrier bundle.

Put a 59/XS on the 11100

51 just shows that you are going to get hit by the multiple surgery reductin rule on the 10040
 
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