A Different Look at Bundled Services – Ophthalmology Management

At this time, we are all fairly well acquainted with the National Correct Coding Initiative (NCCI) edits published by CMS. The “bundles” mean that you bill for the primary procedure but not for incidental services. Additionally, those codes identified as “mutually exclusive” cannot be reimbursed together in the same session. CMS developed NCCI to prevent inappropriate payment for services that should not be reported together. The edits are updated quarterly.

While those instructions account for many bundling edits, do not overlook instructions in the CPT manual itself. Look for restrictive language in the code descriptions such as: “with or without,” “may include” or “with (additional steps)”.

This article addresses the following questions:

  • What are some examples of CPT bundles?
  • What other instructions should we look for in CPT?
  • OK, this is helpful; what else?
  • Back to NCCI edits. When can codes be unbundled appropriately?
  • What about using modifier 59?

This article was published in Ophthalmology Management’s Coding & Reimbursement column, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Ophthalmology Management, click on the link below:


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