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Otolaryngology Coding Alert

Reader Questions:

Decide If 2 Pitfalls Make 'Unbundling' Worthwhile

Published on Fri May 06, 2005

Question: If a commercial carrier is paying separately for procedures the NCCI edits consider bundled, is it appropriate to continue unbundling the codes to the commercial payer?

Maryland Subscriber

Answer: Technically, you may report National Correct Coding Initiative (NCCI) bundled codes to insurers that don't adopt the edit. But before you do, consider these potential problems:
 
1. You will have to report claims differently based on insurer. To capitalize on all ethical reimbursement, you may want to take the extra time to bill this way. But if you don't have a specific coder assigned to each payer or have a lot of claims, you may find this task daunting.
 
2. You must update your policies quarterly. If you find out that a commercial payer will pay differently from the edits' recommendations, you should get the policy in writing.
 
Pitfall: The edits change quarterly, so you need to make sure you get a letter, fax or e-mail confirmation from your carrier on a quarterly basis. This added step will protect you from having to pay back money if the insurer challenges the policy.
 
Example: The NCCI edits bundle nebulizer training (94664, Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device) into the treatment (94640, Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]). But you discover that some commercial payers will separately reimburse the training code.
 
Action: You obtain a hard-copy confirmation that the insurers accept coding 94664 in addition to 94640. When a patient requires a nebulization due to an extrinsic asthma attack (493.02, Extrinsic asthma; with [acute] exacerbation) and inhaler demonstration, you report to:
  
Medicare and insurers that follow NCCI:
  

  • 94664 with 493.02

    Commercial payers:

  • 94664 with 493.02
      
  • 94640.

     - Answers to You Be the Coder and Reader Questions provided by Andrew Borden CCS-P, CPC, CMA, reimbursement manager in the department of otolaryngology and communication sciences at Medical College of Wisconsin in Milwaukee; Rhonda Buckholtz, CPC, administrator at United Community Hospital in Grove, City, Pa.; Barbara J. Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Brick, N.J.

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