Wiki unbundling

[NMURPHY8366]

Hello all.
Does anyone know where I can find documentation on when its acceptable to unbundle, bundled procedures codes using the appropriate modifier? I do orthopedic coding and my docs are always thinking its ok to unbundle codes if its done on the same structure but different areas of the structure. I just need to know where I can get clear documentation on when its acceptable and when its not


Thank you

 

[thomas7331]

The resource I usually go to first for these types of questions (after CPT) is the NCCI Policy Manual which you can find and download from the CMS Medicare web site here:

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

There's a chapter dedicated to each CPT code range and you'll find a lot of detail about the rationales for the bundling edits and when it is allowable to override them with modifiers.

 

[hblakeman]

Global Service Data

I use the Global Service Data through AAOS Code-X. Our orthopedic office uses AAOS guidelines, including the Global Service Data for bundling/unbundling. For each code it lists what's included and not included. For example, for CPT 23472 Code-X GSD lists Tenodesis of Biceps (23430) as NOT INCLUDED, which conflicts with CCI edits. I bill for the tenodesis, with modifier 59 (or X-). If a payer denies, I appeal and include a print out of the AAOS Code-X Global Service Data for that code.

 

[NMURPHY8366]

Thank you ladies