medical Coding and Billing Guidelines For condition Services - Why Unbundling is a Bad Idea

medical Coding and Billing Guidelines For condition Services - Why Unbundling is a Bad Idea When coding and subsequently billing Medicare or a market carrier for services rendered to one of your patients, there are certain guidelines that must be followed by you, the provider. One of these guidelines is not to break down a course into its component parts. This is great known as unbundling.

Medicare is the original assurance company that we deal with and the billing guidelines that will be discussed primarily are in reference to Medicare. Remember that the private assurance carriers very often effect what Medicare does very closely. The excellent example that is utilized to demonstrate how not to unbundle is the hammertoe procedure, 28285. A hammertoe improvement includes, for the most part, those public procedures that often may constitute a single procedure. Medicare considers billing for individual portions of the entire improvement as unbundling and will not pay as such. Consider the following as all included in a hammertoe correction: An excision of a measure of bone, with or without fusion or fixation of the digit, with a K-wire or pin. All skin and soft tissue correction, repair, incision, or excision at the interphalangeal or metatarsal phalangeal joint. multiple exostectomies performed at the same time on the same toe are thought about to be incidental and included in the 28285 surgical fee. A matrix improvement (11750) done in increasing to the hammertoe improvement is usually payable at 50% of the original course code, 28285. Code 14040 is usually not thought about suitable for derotation of the 5th toe. Most carriers will pay this course as 28285 or 28286. Insertion of an interphalangeal implant of toes 2-5 is thought about included in the 28285 reimbursement. Just because you were paid does not mean that you coded correctly. All audits are post-payment with very few exceptions. How do you measure up? medical Coding and Billing Guidelines For condition Services - Why Unbundling is a Bad Idea