Wiki Unbundling if you're out of network


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

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!
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.
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.