Medical Billing Forum

Coding => Coding => Topic started by: cturner75 on March 17, 2010, 09:09:18 AM

Title: 36415 Bundled
Post by: cturner75 on March 17, 2010, 09:09:18 AM
We are having an issue with Caresource is bundling 36415 with 81003.  The denial reason states "This claim line is being disallowed because its procedure code is unbundled per Medicare.".  Does anyone know where I can find information on why Medicare bundles these codes?
Thanks-
Christa
Title: Re: 36415 Bundled
Post by: Michele on March 17, 2010, 01:02:23 PM
Did you try searching the NCD's or the LCD's?

Michele
Title: Re: 36415 Bundled
Post by: Yesica on March 17, 2010, 03:40:51 PM
Why did you  have a venipuncture where's there any blood work done?
Title: Re: 36415 Bundled
Post by: oneround on March 17, 2010, 04:21:45 PM
Correct, why a Veni on a UA Dip?
Title: Re: 36415 Bundled
Post by: Michele on March 18, 2010, 06:54:10 AM
Interesting question, I was assuming there were other services.

Michele
Title: Re: 36415 Bundled
Post by: cturner75 on March 19, 2010, 09:15:58 AM
Yes, I tried locating information under LCD & NCD, but couldn't find anything. 
An office visit was also billed.  We did a blood draw to send to the lab, and also a urinalysis.  Which we do often in our office.
Thanks-
Title: Re: 36415 Bundled
Post by: cturner75 on March 19, 2010, 09:17:31 AM
I should also clarify that the insurance rep was the one who informed us that 36415 was bundled with 81003, not the office visit.
Title: Re: 36415 Bundled
Post by: Michele on March 22, 2010, 06:55:03 AM
Is Caresource a Medicare replacement plan? 

I think at this point I would file a written appeal asking for an explanation of the denial.  My main argument would be that it is not appropriate to bundle 36415 with a urine test, 81003.  Include information as to what the 36415 was performed for. 

Good luck!
Michele
Title: Re: 36415 Bundled
Post by: Chodges on May 20, 2010, 12:10:26 PM
36415 is probably bundling with the E&M and there is a CCI edit out there for that.  If documentation supports an office visit then you can add mod 25 to the E&M.