Wiki Bundled procedures with commercial insurance companyies

[vmounce]

Can someone answer this question for me? I know with Medicare we are not suppose to unbundle procedures that are in the same compartment. For example with the knee. But what about with the commercial insurance companies and workers comp? A doctor's office told me they do. I pretty much follow Medicare's guidelines.

I seen an article sometime back that commercial insurance companies are going to start looking at this. If Medicare don't pay then they are not going to pay. I appreciate any information.

Thank you,
Vickie Mounce

 

[rkmcoder]

Unbundling

Some commercial insurance carriers follow Medicare bundling guidelines (CCI edits) and some do not. As far as ortho coding, AAOS has their own set of bundling guidelines, and many insurances follow that. BCBS, UHC, AETNA and CIGNA have published some guidelines (similar to Medicare LCDs), so look at them. Workers Comp and no-fault are jurisdiction specific, so query your state agencies.

Bottom line is that there are a spectrum of bundling guidelines (and medical necessity guidelines) and getting to know them can be a daunting task. The old standby is to file claims and wait for the outcomes.

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

 

[coderguy1939]

Also, if you have contracts with any of the carriers you might find information there as to what guidelines they would like you to use.