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Archive February 2020 XXI, No. 2

Coding & Billing: Don't Leave Money on the Table

The bundling guidance you follow impacts your reimbursement rates.

Bob Lathrop

Bob Lathrop, CPC, CPC-I, CASCC


National Cardiovascular Partners
SEPARATE CHARGES Coding according to the American Medical Association guidelines could let you earn more for performing two shoulder procedures at one time.

One of your top priorities as a surgical administrator is to maximize reimbursements for the services performed at your facility. That's no small task when dealing with complex, bundled payment arrangements — a group of procedures covered by a single, comprehensive CPT code. There are two methods to use when coding bundled procedures:

  • National Correct Coding Initiative (NCCI) edit bundling. This is CMS's strict set of bundling guidance, which lets providers know which CPT codes may be bundled when their procedures are performed in the same outpatient surgical setting. On top of federal payers, many commercial payers have adopted this bundling guidance because it's easy to apply and clearly spelled out.
  • AMA bundling guidance. The American Medical Association's guidance is less structured than the NCCI edits, meaning it's more likely for providers to report CPT codes separately to increase reimbursement.

If you don't pay close attention to which method your payers use, you could be coding incorrectly or leaving a significant amount of reimbursement money on the table. Let's look at how these bundling methods differ as well as the best practices your coders and billers should use to get the most out of each.

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