Coding > Coding

Bundling?

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blueskyportland:
Hi there! I just joined, and this is my first post, so forgive me if this topic has already been addressed, and please feel free to direct me to the thread in which it has been answered, if any.

I am a self-taught biller/office manager for an alternative healthcare clinic. I've had some tutorial, but have pretty much been learning as I go along. Recently I began billing for our naturopath, who has much more intricate superbills than our acupuncturists or massage therapists. As a result, I've begun to get claims rejected for reasons that seem simple enough, but that have not been explained to me. For instance -bundling and modifiers. I think I get the general concepts, but I don't have any good resources for modifier manuals or code books. We've been getting a lot of claims returned because the return visit codes and therapy codes "cannot be submitted 'unbundled'," however none of the claims departments are able to advise me as to how to bundle. I'm pretty much at a loss - any help you can offer would be greatly appreciated, from resources to specific advice.

As a specific example, for one date of service for a return patient i billed: 99213, 97140, and 96372. The 99213 code was not paid, but the injection 96372 code was - the explanation I received was, as mentioned above, that those two codes cannot be submitted unbundled.

Thanks so much!

PMRNC:
You shouldn't be coding, the doctor should, especially since your not trained, you cannot learn simply by looking at the CPT Code book. The ultimate responsibility of coding falls on the doctor. If you are not qualified or trained, when he hands you the superbill you look it over and if it's not complete, give it back to him. Coding is done using the medical chart and is based on the elements of the E&M, ONLY he is in there with the patient and is responsible for documenting it, therefore responsible for assigning the proper codes and modifiers.

Michele:
Linda is right, you shouldn't be coding.  The dr needs to let you know what was done.

However, If you are simply looking for the modifier that you need to use to have them process the charges separately you may want to try the 25 modifier on the E&M code (office visit).  If the dr is doing the ov and it is completely separate  (which only he can tell you) from the therapy he performed then you can bill the ov with the 25 modifier. 

If you've already done that and they are denying stating they do not allow the codes separately on the same visit there is not much you can do.  You could try to appeal by submitting office notes, etc. but it may not do any good.

Michele

blueskyportland:
thanks for the feedback! i don't do the coding, per se, but i am the only one in the office that does the billing and is very familiar with it, so i'm trying to help us all understand this bundling/modifier issue.
I recently looked up different modifiers that I feel we could use, including 25, 51, and 76. I'm going to try to resubmit the claims using these modifiers but, just so I'm sure about how to use them, could you verify that I just tack them on the end of the code? For example, when billing E/M code 99213 for a service date that also included a primary manual therapy code of 97140, with two subsequent 15 minute periods of administering the manual therapy, i would bill the line items as follows:

99213.25
97140
97140.76
97140.76

thanks again! i'm trying to convince the studio owner to buy some of your books! :)

Michele:
The example you gave is not correct.  I would not use the 76 modifier on the 97140.  I would bill the 97140 with 3 units.

Michele

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