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Bundling issue

  1. #1
    Default Bundling issue
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    Patient came into the ER and had I&D performed (10080). Patient came back to ER two days later as the abscess was getting worse and second I&D (10080) was performed. The insurance is now denying the second 10080 as bundling and I know this CPT has 10 day global period. The second E&M visit was paid, but can we be billing the second 10080 due to the global period?


  2. #2
    Try adding modifier 78 to 10080 to unbundle it.
    Devin Major, CPC
    HCA Healthcare
    Remote Cardiovascular Coder II
    Houston, Texas

  3. #3
    Default Bundling issue
    Thank you! I will try this.

  4. #4
    Quote Originally Posted by devinmajor14 View Post
    Try adding modifier 78 to 10080 to unbundle it.
    You should not "try" modifiers - modifiers must be used only when supported by the medical records. If this procedure was done in the ER, I don't believe modifier 78 would be supported - the ER is not an operating room.

    You might be able to use a modifier 58 if the documentation supports it. But without a return to the OR, a related procedure is inclusive to the global surgical package under most payer policies.
    Thomas Field, CPC, CEMC

  5. Default Medicare Denial 236, for office vist
    Medicare Denial 236, for office vist

    I work for an Urgent care having trouble getting my office visit paid 99201 with Medicare. Medicare paid for the IMMUNIZATION ADMIN and TDAP Vaccine but not he office visit. Can someone please help. Thank you

  6. #6
    Dover Seacoast New Hampshire
    An E&M with an immunization is typically bundled. Unless the E&M supports a separately identifiable issue, you can only bill the immunizaiton/administration. If the documentation supports something other than the need for the Tdap, then add the -25, but make sure your documentation is solid.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  7. Default
    Medical Billing
    Thank you

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