bonessasan
New
There is a bit of a debate going on within my office, and I was wondering what other schools of thought there are out on there on the subject.
Lately our practice has run into many situations where a code with a higher RVU is bundled into a code with a lower RVU by CCI Edits. Our practice manager swears up and down that the insurance companies can't disallow the code with the higher RVU (which we always list as primary) and pay just the lower code. She was the coder before I was hired on, so she does have coding knowledge, but she specializes more in industrial claims rather than commercial claims and the rules are very different.
As a biller I feel it's ridiculous that an insurance carrier can say that a procedure with a lower RVU is more extensive than a procedure with a higher RVU and pay only the lower secondary code. The coder in me can maybe understand that they are correct in terms of the "rules."
My question is this: Are there any guidelines that say that an insurance company should pay a primary code, even when it is considered an integral part of a code with a lower RVU?
Lately our practice has run into many situations where a code with a higher RVU is bundled into a code with a lower RVU by CCI Edits. Our practice manager swears up and down that the insurance companies can't disallow the code with the higher RVU (which we always list as primary) and pay just the lower code. She was the coder before I was hired on, so she does have coding knowledge, but she specializes more in industrial claims rather than commercial claims and the rules are very different.
As a biller I feel it's ridiculous that an insurance carrier can say that a procedure with a lower RVU is more extensive than a procedure with a higher RVU and pay only the lower secondary code. The coder in me can maybe understand that they are correct in terms of the "rules."
My question is this: Are there any guidelines that say that an insurance company should pay a primary code, even when it is considered an integral part of a code with a lower RVU?