Author Topic: medicare billable CPT, bundle codes  (Read 3452 times)

MBP

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medicare billable CPT, bundle codes
« on: September 21, 2009, 01:06:56 PM »
i've read so many posts on this forum over the last few days that now although i do remember reading about combinations of codes and bundles somewhere - cant find it  >:( could someone please tell me where can i find groups of cpt codes that are billable/are not? i tried medicare website, but again, no luck.. case of mondays for me!! ;D e.g. medicare always rejects 99238 for the surgeon i bill for. when she discharges a patient from the hospital, that is never paid for... being new.. - i can't find a modifier i would use as this is not a procedure, but a visit.. so i thought it could be a part of bundled code?

PMRNC

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Re: medicare billable CPT, bundle codes
« Reply #1 on: September 21, 2009, 02:21:43 PM »
Wouldn't the discharge date be a part of the global surgical period?
Linda Walker
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Michele

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Re: medicare billable CPT, bundle codes
« Reply #2 on: September 22, 2009, 08:59:53 AM »
We would have to know the reason that the 99238 is being denied.  Like Linda said, it may be part of the global period, or is it possible another physician billed for the discharge first??

Michele
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MBP

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Re: medicare billable CPT, bundle codes
« Reply #3 on: September 22, 2009, 09:54:07 AM »
i agree it should be, but in some cases (e.g. 19307 or 44950 - global 90 days) some insurances (e.g. health alliance plan) do pay for 99232 (consults after the sx while still in the hospital) and for 99238 (discharge).. i have noticed that the previous biller was using mod 24 in some cases to get paid for 99238.. i dont know if that is correct..  :-\

edypowers

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Re: medicare billable CPT, bundle codes
« Reply #4 on: September 22, 2009, 07:12:41 PM »
You can not bill for the discharge.  It is included no matter how many global days in the global period. If it is a 0 day global period then it is most likely and out patient.

jsummey

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Re: medicare billable CPT, bundle codes
« Reply #5 on: October 06, 2009, 11:57:43 AM »
I am having a problem with bundled codes as well.
For one specemen I am billing 88305 and 88108, the other specemen (same area) I am billing 88173 which is getting denied as bundled with 88108.  Since 88173 is for a different specimen wouldn't I code that with a 59 modifier?  The other girl here said she looked up the three codes and it showed that 88108 should get the 59 modifier but that doesn't make sense to me.  Please verify.  :-)

jsummey

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Re: medicare billable CPT, bundle codes
« Reply #6 on: October 06, 2009, 12:00:18 PM »
Oops....misspelled specimen.  :-)

Michele

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Re: medicare billable CPT, bundle codes
« Reply #7 on: October 06, 2009, 08:18:59 PM »
Since there really isn't a modifier to indicate separate specimen it sounds like the 59 may be your only option.  It may still get denied or bundled but you will just have to appeal.

Michele
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