|May 2006 · Vol. 18, No. 5
Don’t fail to dispute inappropriate bundling
RN, CPC-OGS, MA
You can bill a consultation with a diagnostic procedure on the same day and both will be paid
Independent coding and documentation consultant; former program manager, Department of Coding and Nomenclature, American, College of Obstetricians, and Gynecologists
Q A patient’s insurance company bundles an ultrasound procedure with a consultation, and quotes Medicare rules as the basis. For instance, we bill 99242 (Office consultation; expanded problem focused history and exam with straightforward medical decision-making) with 76811 (Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation) and the services are being provided by a maternal-fetal specialist.
I have appealed many times, but they refuse to pay for both. Do you have any suggestions?