Author Topic: 36415 Bundled  (Read 3722 times)

cturner75

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36415 Bundled
« 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

Michele

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Re: 36415 Bundled
« Reply #1 on: March 17, 2010, 01:02:23 PM »
Did you try searching the NCD's or the LCD's?

Michele
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Yesica

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Re: 36415 Bundled
« Reply #2 on: March 17, 2010, 03:40:51 PM »
Why did you  have a venipuncture where's there any blood work done?

oneround

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Re: 36415 Bundled
« Reply #3 on: March 17, 2010, 04:21:45 PM »
Correct, why a Veni on a UA Dip?
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

Michele

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Re: 36415 Bundled
« Reply #4 on: March 18, 2010, 06:54:10 AM »
Interesting question, I was assuming there were other services.

Michele
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cturner75

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Re: 36415 Bundled
« Reply #5 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-

cturner75

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Re: 36415 Bundled
« Reply #6 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.

Michele

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Re: 36415 Bundled
« Reply #7 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
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Chodges

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Re: 36415 Bundled
« Reply #8 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.