36415 Bundled

[cturner75]

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]

Did you try searching the NCD's or the LCD's?

Michele

[Yesica]

Why did you  have a venipuncture where's there any blood work done?

[oneround]

Correct, why a Veni on a UA Dip?

[Michele]

Interesting question, I was assuming there were other services.

Michele

[cturner75]

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]

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]

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

[Chodges]

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.

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