Unbundling if you're out of network

stonecm

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Our Dr. is not in network with any insurance except Medicare. The coder before me reported:
62310
64479
72275
77003

I know 77003-26 can be reported with 62310, but I would not report 72275 because fluoro is included with the injection codes and a formal epidurogram wasn't performed. *Imaging guidance (fluoroscopy or CT) and any injection of contrast are inclusive components of 64479-64484. Imaging guidance and localization are required for the performance of 64479-64484*

BLue Shield insurance paid on the 64479 and 72275 but did not pay the other lines stating they were bundled. Our collector told me that I can balance bill for the other service becuase we are out of network, but I didn't think we could balance bill the patient for procedures that were unbundled. Our collector insists that unbundling doesn't apply to out of network claims, but I wanted to make sure before I bill the patient.

Any advise is greatly appreciated!
 

stonecm

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Thanks, that is what I was thinking too. :) I couldn't find anything other than what is in CPT so if we have to refund/write off I want to be able to tell the Dr. why.
 

drakena74

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Local Chapter Officer
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Fullerton, CA
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Your collector is so wrong. Cathy is right it also follows billing guidelines as well. You can look on the insurance website for the coding & billing policies for the above procedures and it usually spells it out for you what you can and cannot do.
 
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