Wiki Need help please! CPT 24105 & 24110

[slimjohnson11@hotmail.com]

A provider has appealed stating that these two procedures CPT 24105 & 24110 were performed separate and distinct from each other on the same day. Should we be overturning this appeal or should they have used a modifier when original claim was billed?

 

[thomas7331]

Under CMS/NCCI rules, 24105 bundles to 24110 but does allow for a modifier to unbundle if supported, but every payer has its own policies with regard to bundling and reimbursement, which may involve other factors beyond NCCI. I cannot tell you whether or not you should be overturning this without knowing your organization's policies and whether or to what extent your policies follow NCCI, so I would recommend you rely on your internal resources for guidance on the correct process for this.