# All is bundled?!? help



## BFAITHFUL (Apr 2, 2010)

I have kind of a dumb question, but I'm going to ask it anyway....
our doc does right transforaminal inj (64483 + 77003) for lumbar disc disease and major joint injection (20610 + 77002) for hip bursitis. Both done under fluro. guidance
According to CCI edits... 20610 & 77002 is bundled with 64483, & 77003 is bundled with 77002 so mostly everything is bundled with each other. I know I can bill them because its for a diff. dx/area. So shouldn't I then be coding it as the following? 

64483-RT 722.93 (disc disease not further specified)
77003-59 722.93
20610-59 726.5
77002-59-26 726.5

Thanks


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## rkmcoder (Apr 2, 2010)

20610 bundles into 64483 with a modifier allowed.  77003 bundles into 77002 with a modifier allowed.  So I think you have one to many -59 modifiers.  Here is what I would do:

64483-RT
77003-59
20610-59-(add a -RT or -LT here)
77002

AND, kudos to you on getting lumbar disc disease right.  Some people look in the ICD-9 Index and see DISEASE - DISC, DEGENERATIVE and end up with a 722.5x code, which is wrong.  Dig a bit deeper and look at DISEASE - INTERVERTEBRAL DISC and you will find the proper 722.7x or 722.9x codes.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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## BFAITHFUL (Apr 2, 2010)

thanks...... we would get denial bcuz 77002 would be bundled with 77003? since CCI edits does show 77002 inclusive to 77003?    

that's what I was wondering at first, so many 59 modifiers, but then how can i bypass 77002 not getting bundled with 77003?


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## eblanken (Apr 3, 2010)

Bfaithful-

You are correct, the 20610, 77002, & 77003 will all need a 59 to unbundle them from the CCI edits. When I validate the codes it gives me the following info:

64483 - no bundling issues
20610 - Code 20610 is a component of Column 1 code 64483 but a modifier is allowed in order to differentiate between the services provided.
77002 - Code 77002 is a component of Column 1 code 64483 but a modifier is allowed in order to differentiate between the services provided.
77003 - Code 77003 is Mutually Exclusive of Column 1 code 77002 but a modifier is allowed in order to differentiate between the services provided.


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## dwaldman (Apr 4, 2010)

This link has a good guidance of coding the 722 codes. Are you saying that if they say lumbar disc disease that they are not specifying degenerative so you can not use 722.4,722.5X, or 722.6. Under 722.6 it says Degenerative disc disease NOS.



http://www.asnr.org/spine_nomenclature/

Sub-categorizations 722.4, 722.5, and 722.6 are for "Degeneration of intervertebral disc" in the cervical, thoracic or lumbar, and unspecified regions, respectively. Instructional Notations specify inclusion of "degenerative disc disease" and "narrowing of intervertebral disc or space."

Sub-categorization 722.7 is labeled "Intervertebral disc disorder with myelopathy." It does not specify displacement of the disc. Fifth digits are added for regional location. Sub-categorization 722.8 is labeled "Postlaminectomy syndrome."

"Other and unspecified disc disorder" is the diagnostic label of 722.9, with Instructional Notations to include "calcification of intervertebral cartilage or disc" and "Discitis." Observations of imaging variations of unknown significance can be coded 793.7, which ICD-9-CM describes as "Nonspecific abnormal findings on radiological and other examination of body structure, Musculoskeletal."

A disc described as "bulging" without further specification as to the cause of the bulging should not be coded as a displacement, but, like other observations of uncertain significance as 722.9 "other and unspecified disc disorder" or as 793.7, "nonspecific abnormal findings on radiographic examination" (musculoskeletal).


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## rkmcoder (Apr 5, 2010)

What I am saying is that if the operative report indicates disc disease then code disc disease, do not code degenerative disc disease.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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## hgolfos (Apr 5, 2010)

I would only add one thing.  Does your physician own the fluoro equipment?  If not, you need a 26 (professional component) mod on both fluoro codes.


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## BFAITHFUL (Apr 5, 2010)

no he doesn't own fluro machine, it was done at an ASC, 
that's right I did mean to put 26 modifer with both 77xxx codes,   thanks!!


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