Bundling Medical Insurance Codes – Stop losing money on “bundled” medical insurance claims

What is “bundling” anyway? It is when an insurance company combines two or more CPT codes, replacing one overarching code, often ignoring modifiers along the way. This practice can reduce your progress. When codes are bundled, the codes are grouped together and the insurance company will only allow the allowance for the code they believe is appropriate.

There are ways to get around bundling. First, you need to make sure you invoice the claim correctly on the initial filing. For example, if you bill an E&M code for a patient who comes in with high blood pressure, but the patient also complains of knee pain and you end up doing a knee joint aspiration, make sure you have the right modifiers to indicate what you you are doing. You want to bill the E&M code, say it’s a 99213, with a 25 modifier to indicate it’s a separate and distinct service offered during the same visit. Then you would bill the knee joint aspiration with the appropriate code using a 59 modifier to indicate a separate procedural service.

It is quite necessary to know the proper use of all the different modifiers to get full compensation for your services. Equally important is also the ability to correctly read an EOB (statement of benefits statement). EOBs can be quite complicated and it’s important to understand what the insurance company has done with the claim.

When the claim is processed and you receive the EOB, make sure that the insurance company has allowed both codes separately. After all, you have been in the office to manage your high blood pressure and you did the aspiration completely separate from the office visit.

If the insurance company bundles your codes, you must object. In many cases, the insurance company will reprocess the claim and disconnect the codes as you go through the appeals process.

The appeal does not have to be complicated. It can be a form letter that you design where you just need to fill in the blanks. Many carriers bundle the claims at initial processing because most offices do not appeal the claim. Think how much money they save!

You may think it’s not worth appealing, but you might be surprised if you knew how much money you’ve actually lost over time. If you have a system to file an appeal, it’s a fairly straightforward process. It doesn’t take much time and you can increase your progress. In my opinion it is worth it.

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Copyright 2007 – Michele Redmond