Friday, April 6, 2012

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

Medical Billing And Coding Online - 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

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When coding and subsequently billing Medicare or a market carrier for services rendered to one of your patients, there are inevitable guidelines that must be followed by you, the provider. One of these guidelines is not to break down a procedure into its component parts. This is good known as unbundling.

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Medical Billing And Coding Online

Medicare is the primary guarnatee company that we deal with and the billing guidelines that will be discussed primarily are in reference to Medicare. Remember that the private guarnatee carriers very often result what Medicare does very closely.

The superior example that is utilized to demonstrate how not to unbundle is the hammertoe procedure, 28285.

A hammertoe revising includes, for the most part, those communal procedures that often may constitute a singular procedure. Medicare considers billing for personel portions of the entire revising as unbundling and will not pay as such.

Consider the following as all included in a hammertoe correction:

An excision of a quantum 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 revising (11750) done in increasing to the hammertoe revising is commonly payable at 50% of the primary procedure code, 28285. Code 14040 is commonly not thought about approved for derotation of the 5th toe. Most carriers will pay this procedure 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 quantum up?

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