To Bundle or Not to Bundle in Medical Billing - dummies

To Bundle or Not to Bundle in Medical Billing

In medical billing, you can link some services together under one code, also known as bundling. This is helpful because a physician may have performed one service as the result of doing another. Other times, codes describing services considered to be inclusive to each other (that is, performed as part of a single procedure) can be billed separately.

Knowing what to bundle or not is a skill that comes with practice and learning the ins and outs of your coding resource books.

Bundle basics

Whether procedures can be billed separately or not depends on what goes on during the surgery:

  • If additional skill and time are required to do the extra work, then the other procedure may qualify for additional reimbursement.

    For example, closure of a surgical opening is part of the surgery. But if the closure is a complex procedure that involves an extensive amount of time and skill, then you may be able to unbundle those services. Unbundling means that two or more codes that are normally incidental to another can be billed separately. To do that, you apply the individual codes and a modifier to bypass the edit.

  • If the physician performed the procedure because he was already working on that part of the body, it’s incidental and not separately billable. If, for example, a surgeon is performing abdominal surgery and decides to remove the patient’s appendix as well, you can’t bill for the appendectomy, because the surgeon was already in there.

  • Bundling can refer to a procedure that had to be done to successfully complete the primary procedure. Think about incisions and repairs. Before a surgeon can enter the body, an incision has to be made; therefore, it’s not really a separate procedure. After the physician completes the surgery, the incision needs to be closed. Closure is not separate; it’s a pretty important part of the procedure.

If you use coding software, the software indicates when two or more procedures are incidental to another. If you don’t use coding software, you can go to the Medicare website and most Medicare contractor websites to find out what the proper edit is.

You use modifiers to indicate that the procedure being billed has been modified or altered from its published description. You don’t use them purely to seek additional reimbursement.

How to deal with bundling errors

Most payer processing software programs identify bundling errors, or more accurately, they identify procedures that have been unbundled improperly. They don’t identify procedures that should have been included but that are missing. It’s your responsibility as the coder to review the medical documentation and identify all billable procedural codes.

Not all payer processing software identifies bundling errors. If you submit claims to those payers, the claim will pay as you billed it. Keep in mind, however, that this doesn’t give you carte blanche to over-code.

When you over-code, you take advantage of payers by submitting procedures that will pay but that are not supported in the record. The provider you work for is bound by ethics to submit truthful claims. Just because a payer will allow it, doesn’t mean you should bill it when unbundling is not supported.