Natalie Posted Tue 05th of November, 2013 18:28:59 PM
Per your CCI edits checker, I can bill CPT code '60260' with CPT code '60500' if I use a modifier -59 on CPT code '60500'. However, I have a local payor denying this, stating that these codes are bundled per CMS guidelines. I have not been able to locate this guideline-the only CCI edit I found was CPT code '60240' and that does show CPT code '60500' bundled into it and unbundling is NEVER allowed, even though your edits checker shows that '60500' can be unbundled and billed with CPT code'60240'. The bottom line is, can CPT code '60260' and CPT code '60500' be billed together and paid?
SuperCoder Answered Tue 05th of November, 2013 19:13:53 PM
Because '60260' and '60500' pass CCI edits and there is nothing in the CPT coding guidelines that say they cannot be billed together, yes, they can be billed together. The burden of proof is now on your local payer to show you in writing where they are bundled under CMS guideline; otherwise, they must reimburse you as billed.