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Wiki HELP 31624 Denial
- Thread starter ndriley10
- Start date
hcg
Guru
I am getting a denial for bundling with 31622 every time I bill 31624. The problem is that I'm not billing 31622 at all only the 31624 code. Is this not a code that can be billed alone? Does anyone else have this problem or know how to fix it?
I have not tried billing 31624, but only 31622. Have you tried calling the insurance carrier & ask them why? Most of the time they will send it back for reprocessing especially if the denial does not make sense, or perhaps was there another doctor who billed 31622? Just a thought
tceesay
Contributor
I just received a bundling edit for 31624 and 31623. I'm not sure why.
lisigirl
Expert
So you're not billing anything but 31624 and insurance is denying the entire claim stating it is bundled? If that is the case, I would call the payer about that. However, if you're billing multiple bronchoscopy codes at one time, the payer may be following endoscopic payment rules.
CPT 31622 is the base code for most of the codes between 31623-31661 (you can refer the MFSDB for this info). If you bill for multiple bronchoscopy procedures at one time, the first procedure is paid at 100% but then the base code is subtracted from the 2nd, 3rd,
4th, etc procedures. So, if the RVU assigned to 31624 are less than what is assigned to 31622, you won't get an additional payment on this code (because they subtract the 31622 RVU from the 31624 RVU and pay the difference).
Does that make sense?
Lisi, CPC
eharkler@nmh.org
CPT 31622 is the base code for most of the codes between 31623-31661 (you can refer the MFSDB for this info). If you bill for multiple bronchoscopy procedures at one time, the first procedure is paid at 100% but then the base code is subtracted from the 2nd, 3rd,
4th, etc procedures. So, if the RVU assigned to 31624 are less than what is assigned to 31622, you won't get an additional payment on this code (because they subtract the 31622 RVU from the 31624 RVU and pay the difference).
Does that make sense?
Lisi, CPC
eharkler@nmh.org
also getting bundling edits with 31623 and 31624
I've had trouble with this issue as well. Cigna gave a response regarding not paying both 31624 and 31623. I thought those codes were subject to multiple endoscopy payer rules but they could still be billed together. See Cigna's respose below. Anyone have any calrification on this?
Why is procedure 31623 disallowed when submitted with procedure 31624?
Procedure Description
31623 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS
31624 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
Response:
Procedure 31624 is used to report a bronchoscopy with bronchial alveolar lavage. A bronchoscopy is an examination of the bronchi utilizing a bronchoscope passed through the trachea to allow visual inspection of the tracheobronchial tree. Specimens for biopsy are obtained by lavage of the suspected site through the bronchoscope using sterile saline, followed by aspiration of the fluid specimen(s)into a syringe and transfer to lab container. This procedure includes fluoroscopic guidance if needed.
Procedure 31623 is used to report a diagnostic bronchoscopy with brushing or protected brushings. A bronchoscope is inserted and advanced to the bronchus. The area is inspected visually and brushings or protected brushings are performed.
Certain procedures are commonly performed in conjunction with other procedures as a component of the overall service provided. An incidental procedure is one that is performed at the same time as a more complex primary procedure and is clinically integral to the successful outcome of the primary procedure.
Edits are not solely influenced by the RVU value, although it is always considered. The surviving code is the procedure believed to be the more clinically intense procedure.
Modifier -59 may be used to identify the performance of a distinct procedural service, unrelated to the primary procedure.
An assumption of same anatomic site is made during the auditing process.
Site specific modifiers may be used to denote the performance of these procedures at different anatomic sites.
"Health Plan Policy (HPP)" edits are sourced to a specific benefit, medical or payment policy. Health Plans concur that these edits edit are consistent with current health plan policies.
Consistent with other endoscopic sections of the CPT manual, many endoscopic procedures with brushings represent diagnostic endoscopic procedures. CPT guidelines for endoscopy state, "Surgical bronchoscopy always includes diagnostic bronchoscopy when performed by the same physician." Thus, bronchoscopy with brushings or protected brushings is considered integral to the surgical bronchoscopic procedure.
Furthermore, the National Correct Coding Initiative's (CCI) recommendations to edit or not to edit are considered during the edit development process, however the presence or absence of a CCI edit does not guarantee its' incorporation within the code auditing logic. As with other nationally recognized sources, CCI recommendations are adopted only when criteria that ensure clinical integrity and defensibility are met.
Therefore, procedure 31623 is not recommended for separate reimbursement when submitted with procedure 31624.
I've had trouble with this issue as well. Cigna gave a response regarding not paying both 31624 and 31623. I thought those codes were subject to multiple endoscopy payer rules but they could still be billed together. See Cigna's respose below. Anyone have any calrification on this?
Why is procedure 31623 disallowed when submitted with procedure 31624?
Procedure Description
31623 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS
31624 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE
Response:
Procedure 31624 is used to report a bronchoscopy with bronchial alveolar lavage. A bronchoscopy is an examination of the bronchi utilizing a bronchoscope passed through the trachea to allow visual inspection of the tracheobronchial tree. Specimens for biopsy are obtained by lavage of the suspected site through the bronchoscope using sterile saline, followed by aspiration of the fluid specimen(s)into a syringe and transfer to lab container. This procedure includes fluoroscopic guidance if needed.
Procedure 31623 is used to report a diagnostic bronchoscopy with brushing or protected brushings. A bronchoscope is inserted and advanced to the bronchus. The area is inspected visually and brushings or protected brushings are performed.
Certain procedures are commonly performed in conjunction with other procedures as a component of the overall service provided. An incidental procedure is one that is performed at the same time as a more complex primary procedure and is clinically integral to the successful outcome of the primary procedure.
Edits are not solely influenced by the RVU value, although it is always considered. The surviving code is the procedure believed to be the more clinically intense procedure.
Modifier -59 may be used to identify the performance of a distinct procedural service, unrelated to the primary procedure.
An assumption of same anatomic site is made during the auditing process.
Site specific modifiers may be used to denote the performance of these procedures at different anatomic sites.
"Health Plan Policy (HPP)" edits are sourced to a specific benefit, medical or payment policy. Health Plans concur that these edits edit are consistent with current health plan policies.
Consistent with other endoscopic sections of the CPT manual, many endoscopic procedures with brushings represent diagnostic endoscopic procedures. CPT guidelines for endoscopy state, "Surgical bronchoscopy always includes diagnostic bronchoscopy when performed by the same physician." Thus, bronchoscopy with brushings or protected brushings is considered integral to the surgical bronchoscopic procedure.
Furthermore, the National Correct Coding Initiative's (CCI) recommendations to edit or not to edit are considered during the edit development process, however the presence or absence of a CCI edit does not guarantee its' incorporation within the code auditing logic. As with other nationally recognized sources, CCI recommendations are adopted only when criteria that ensure clinical integrity and defensibility are met.
Therefore, procedure 31623 is not recommended for separate reimbursement when submitted with procedure 31624.
dreamer662
Contributor
- Messages
- 16
- Best answers
- 0
Bundling issue for 31623 and 31624 - please help
Hi,
I am receiving edits when i am billing 31624 and 31623. I received the same message as the post above about Cigna. Can someone please let us know if they are bundled or if a modifier 59 can be added to 31623.
I am billing
31628
31623
31624
31627
all the codes got paid except 31623 - the clear claim edit stated that it is bundled with 31624.
Thanks
Hi,
I am receiving edits when i am billing 31624 and 31623. I received the same message as the post above about Cigna. Can someone please let us know if they are bundled or if a modifier 59 can be added to 31623.
I am billing
31628
31623
31624
31627
all the codes got paid except 31623 - the clear claim edit stated that it is bundled with 31624.
Thanks