What exactly is “packaging” anyway? This is when an insurance company combines two or more CPT codes, substituting for a general code, often ignoring modifiers along the way. This practice can reduce your accounts receivable. When codes are grouped, the codes are grouped and the insurance company will only allow rate schedule assignment for the single code it deems appropriate.
There are ways to avoid bundling. First, you must ensure that you are billing the claim correctly in the initial submission. For example, if you are billing an E&M code for a patient who comes in with high blood pressure but the patient also complains of knee pain and ends up doing a knee joint aspiration, then you need to make sure you use the correct modifiers. to indicate what it is doing. You want to bill the E&M code, let’s say it’s a 99213, with a modifier of 25 to indicate that it’s a separate and distinct service provided during the same visit. You would then bill the knee joint aspiration with the appropriate code using a 59 modifier to indicate a different procedural service.
Knowing the proper use of all the different modifiers is very necessary to get full reimbursement for your services. The ability to correctly read an EOB (explanation of benefits statement) is also important. EOBs can be quite complicated and it is important to understand what the insurance company did with the claim.
When the claim is processed and you receive the EOB, you must make sure that the insurance company allows both codes separately. After all, she had an office visit to check for high blood pressure and performed suctioning, which was completely separate from the office visit.
If the insurance company bundles your codes, you must file an appeal. In many cases, the insurance company will reprocess the claim and unbundle the codes if it goes through the appeal process.
The appeal does not have to be complicated. It can be a form letter that you design where you just need to fill in the blanks. Many carriers bundle claims into initial processing because most carriers do not appeal the claim. Just think how much money they save!
You may think appealing isn’t worth the time, but you’d be surprised how much money you actually lost over time. If you have a system in place for filing appeals, which is a fairly simple process, it won’t take a lot of time and may increase your accounts receivable. In my opinion, it’s worth the effort.
Copyright 2007 – Michele Redmond
