Wiki un-bundle legal cases

[PLAIDMAN]

My coding department is being told not to bundle any coding on our Legal cases...these cases are not submitted to ins.company, the charges sit under a letter of protection until the case is settled.

We have always gone by NCCI edits in our practice, but now we are being told not to bundle any procedures for legal cases...."they pay for anything with a code"

Of course we will follow CPT, but other than that I am not sure I need to be concerned about this ?

If the legal company accepts all charges do I need to be worried?

Thanks for any advice.

 

[thomas7331]

Unbundling is considered fraudulent, I wouldn't do it, at least certainly not without the consent of the payer and/or a better understanding of their payment rules. If they are reimbursing based on codes and the associated RVUs, then by unbundling you would basically be overcharging and duplicate billing them for the services rendered.

 

[ehanna]

My coding department is being told not to bundle any coding on our Legal cases...these cases are not submitted to ins.company, the charges sit under a letter of protection until the case is settled.

We have always gone by NCCI edits in our practice, but now we are being told not to bundle any procedures for legal cases...."they pay for anything with a code"

Of course we will follow CPT, but other than that I am not sure I need to be concerned about this ?

If the legal company accepts all charges do I need to be worried?

Thanks for any advice.

I am in agreement with Thomas. Unbundling is fraud. You say "Of course we will follow CPT" but if you are unbundling you are not following CPT... I too believe you should do more research on your contract work. Good luck!!