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Wednesday, December 2, 2009

Medical Coding and Billing Guidelines For Health Services - Why unbundling is a bad idea

When coding, and then made billing Medicare or a commercial carrier for service to one of your patients, there are certain guidelines that you must follow the manufacturer. One of the proposals is not to break a process into its component parts. This is better known as unbundling.

Medicare is the first insurance company that we are on your statement and guidelines that will be discussed primarily in relation to Medicare. Remember that the privateInsurers often follow Medicare, which is very close.

The classic example that is used to show how not to unbundle the hammer toe procedure is 28285th

A hammer toe correction includes, for the most part, the collective process that can often be a single procedure. Medicare considers billing for individual parts of the entire correction as unbundling and not charged as such.

Consider the following as all those who in a hammer toeCorrection:

Excision of part of the bone, with or without fusion or fixation of the body, with a K-wire or pin.
All skin and soft tissue correction, repair, cutting or excision of the interphalangeal and metatarsal-phalangeal joint.
Several exostectomies be carried out simultaneously on the same footing as random and the OP-28285 fee.
A matrix correction (11750) is performed in addition to the hammer toe correction is usually payable at 50% ofPrimary procedure code 28285th
Code 14,040 is not considered generally useful derotation of the 5th Toe. Most airlines will pay for this procedure than 28,285 or 28,286.
Placing an implant interphalangeal of the toes 2-5 is contained in the 28,285 as a refund.

Just because you paid does not mean that you are properly encoded. All tests will be after the payment, with very few exceptions.

How do you measure up?

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