Wiki CPT 64721 & 25310 - bundled?

[csavitz]

We billed a medicare replacement plan with 64721, 25310 and 25447. The paid for 25310 and 25447 but stated that 64721 is bundled with 25310. Is this correct? I have not been able to find this information independently. Any help would be appreciated. Thanks!

 

[Orthocoderpgu]

At this time there is no edit conflict between the codes. And I will not try to say if it's right or wrong to bundle them. But I can understand the possible reasoning behind it. Coding instructions state that smaller procedures are usually bundled with larger procedures when performed in the same anatomical area. Both 25310 & 64721 are both performed on the volar aspect of the arm. The incisions would not be that far apart. Maybe that is what the insurance is thinking. Who knows? Since there is no NCCI edit conflict, I doubt you would find any concrete information regarding the bundling of these codes. Someone may surprise us though.

 

[amyjph]

Agree with above, there is no edit. However, we would need more information/op report and the specific line items and diagnosis pointers to be able to understand why. There are a lot of reasons why this could be. Depends on the payer too. I also don't recall normally see 64721 with those other procedures at the same time.
Do they think it was done for exposure? Did the patient have carpal tunnel syndrome? Are the diagnosis codes assigned to the CPT correctly? Does that payer have a guideline about it?
If you feel everything is correct and the op report supports it you could appeal with documentation.

diagnosis codes, diagnosis coding