Author Topic: how to unbundle codes that were bundled for clinical laboratory drug screen  (Read 1134 times)

brandilyon

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Hi,
Hopefully someone can help me resolve this matter. I work for a billing company that bills drug screen testing for an in house laboratory. On a recent claim the insurance provider bundled a few procedure code that were not suppose to be bundled. Therefore I will need to provide documentation that supports these codes not being bundled together. the only problem is that I am unsure of what type of documentation I need to submit for reconsideration. A letter of reconsideration is not enough. The insurance company is need other type of documentation and not just my word. Has anyone else come across this issue and had success in unbundling to receive payment? The specific code that are being bundled are as follows; 83840,82542 included with 83925; and 80160,80166,80174,80182 are included with 80152. Please help!!!

shanbull

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This is something the insurance company has to answer for you. You can't be expected to know what documentation is needed if they don't even know. This happens a lot, reps are not generally knowledgeable about specifics. Call the insurance company again and if the rep can't tell you what documentation is needed, ask to speak with the rep's supervisor or to be transferred to the department that actually makes the decisions about this set of procedure codes. These people tend to actually know what they're talking about. Sometimes you get the runaround several times, but if you keep calling, there will eventually be a rep that can help connect you with the person you need to talk to. The reason for this is that the customer service/help center reps have a very high turnover rate, so a lot of the time you're talking to someone who has been on the job for less than two weeks.
« Last Edit: July 17, 2013, 01:36:10 PM by shanbull »