Unbundled Relationships

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Hello All,

I was hoping that someone would be able to help me out regarding the Unbundling of CPT codes:
I received a provider remittance advice from an insurance company that rejected coding that was done for a claimant. The bill was rejected because the following codes have an "unbundled relationship" with oneanother: CPT codes 95904 and 95861. They cannot be billed together and we don't know why. Based on the insurance company, sometimes it was paid and sometimes it wasn't. All of a sudden, United Healthcare is rejecting the codes being billed together. Can someone define "Unbundling?" Does it simply mean that certain codes can't be billed together??
The other codes that we were told could not be billed together OR have an "unbundled relationship" are CPT codes 95900 and 95903.

It appears that there is alot of inconsistency here. The insurance companies are not giving us the same answers when these CPT codes are billed together. Sometimes they pay it and sometimes they reject it saying that the codes have a "Unbundled Relationship"

Can someone verify the meaning of "unbundled relationship?"
Thanks!
 

aaron.lucas

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Per NCCI there is a "soft edit" (meaning -59 is allowed) on 95900 when billed with 95903. this is because the "without f-wave" test is considered included in the "with f-wave" test when done on the same nerve. if they are on separate nerves then -59 is allowed to represent the separate anatomical location. as far as 95861 and 95903/95904, as of 2012 the "old" emg codes (95860-95864) can no longer be billed with NCV. there are new add-on codes 95885-95887 for emg's when NCV is done on the same day. not sure if that's your issue but that's one possibility. the "unbundled relationship" may just be that insurance company's way of saying that there is an NCCI edit in place. You could try calling the insurance company and asking exactly what that verbiage is meant to represent.
 

sedel1156

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I would love to have some feedback on a similar situation: This involves Inpatient billing for separate services on the same day. The patient was seen by the provider in the morning and progress note was entered and billed out. Later, after processing 99232, I get the discharge summary for the same date of service, since the patient was discharged later in the day. So, I have 99232 that has been billed and 99238 both being reported for the same day. CPT 99232 has an unbundle relationship with CPT 99238 because they have both been reported for the same DOS. Is it correct to not bill 99238 since 99232 has already been processed? Or, is there a modifier that I can attach to the discharge in order to process it? My gut feeling is that I should not bill the discharge.
Thanks in advance for your input!
 

mk2001

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I would love to have some feedback on a similar situation: This involves Inpatient billing for separate services on the same day. The patient was seen by the provider in the morning and progress note was entered and billed out. Later, after processing 99232, I get the discharge summary for the same date of service, since the patient was discharged later in the day. So, I have 99232 that has been billed and 99238 both being reported for the same day. CPT 99232 has an unbundle relationship with CPT 99238 because they have both been reported for the same DOS. Is it correct to not bill 99238 since 99232 has already been processed? Or, is there a modifier that I can attach to the discharge in order to process it? My gut feeling is that I should not bill the discharge.
Thanks in advance for your input!
Both cannot be billed for the same DOS and same provider. Check out C. Subsequent Hospital Visit and Discharge Management on Same Day.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1460CP.pdf

Hope this helps.
 
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