Author Topic: How do I bill for bundled codes?  (Read 1511 times)

Alice Scott

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How do I bill for bundled codes?
« on: March 02, 2008, 05:39:55 AM »
Question
hi
How do I bill for bundled codes for proced 84436,
84443, 36415 to BCBS as claim denied.
vemuri

Answer
Hi,

   I am assuming that the 84436, the 84443, & the 36415 are being bundled together.  If that is the case, I would recommend that you look at using modifier 59 which indicates:

59 Distinct Procedural Service: Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day.  Modifier 59 is used to identify procedures/services that are not normally
reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in
extensive injuries) not ordinarily encountered or performed on the same day by the same physician. However, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if there is not a more descriptive modifier available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

If the 59 modifier is appropriate, it may help with getting the codes processed individually.  However, if BC's policy is to never allow those codes separately, then the 59 modifier may not help.

Michele
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patbaylon

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Re: How do I bill for bundled codes?
« Reply #1 on: March 16, 2008, 10:35:12 PM »
These appear to be lab codes. What other codes are you billing on the claim? Did BCBS replace these codes with another on the EOB and pay the new code? 36415 is most of the time considered a part of the E&M service and not paid separately.