How do you choose between a bundled CPT code and reporting multiple individual procedures?

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Choosing between a bundled CPT code and reporting multiple individual procedure codes depends on whether the procedures are considered part of a single comprehensive service or separate, distinct services.

Key Considerations:

1. Check CPT Code Descriptions and Guidelines:
   CPT codes often include bundling instructions that specify when related procedures are included in a single code. For example, a major surgery code might include smaller, related procedures performed at the same time.

2. Understand Bundling (Global Packages):
   Bundled codes cover multiple steps or related procedures to avoid duplicate billing. Using bundled codes prevents unbundling, which is billing separately for procedures that are already part of a comprehensive code.

3. Use Multiple Codes Only if Procedures Are Distinct:
   Report individual codes when the procedures are separate, distinct, and not included in a bundled code. Sometimes modifiers (like Modifier 59) are required to indicate distinct services.

4. Review Payer Policies:
   Insurance carriers may have specific rules about bundling and unbundling. Always verify payer guidelines to avoid claim denials.

5. Example:

   • Bundled: CPT 27447 (Total knee replacement) includes related soft tissue work, so you don’t code those separately.

   • Separate codes: If you perform a knee arthroscopy (29881) and a meniscectomy (29880) separately, you may code both, possibly with modifiers.

Summary:

• Use bundled CPT codes when the procedure is comprehensive and includes related services.

• Use multiple codes only when procedures are distinct and separately billable.

• Always consult CPT manuals, coding guidelines, and payer rules to ensure correct coding.

Proper selection avoids billing errors, reduces claim denials, and ensures accurate reimbursement.

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