By recei What Is Bundled denial in Medical Billing?
This denial is the most common denial code that you will see while dealing with underpayment as it refers to the use of a single CPT code to describe separate procedures were performed and are billed together for reimbursement which include the cost of the minor procedure as well as the major procedure. This process is commonly used for procedures that are typically performed together as part of a treatment plan, such as preoperative and postoperative care or diagnostic testing and follow-up services.
National Correct Coding Initiative: Always Check NCCI edits prior to claim submission; edits are updated quarterly on CMS’ website
Example: When a needle is inserted as part of a more complex procedure, only the CPT code for the more complex procedure which is also considered the major cpt should be used.
Denial Reason, Reason/Remark Code(s)
- M-80: Not covered when performed during the same session/date as a previously processed service for the patient
- CO-B15: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
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Remark code M15: The services or tests billed separately have been combined because they are deemed to be parts of a single comprehensive procedure.
How to address Bundled scenario
- Some of the CPT codes which have similar functions are considered to be Bundled, Inclusive and mutually exclusive according to NCCI edits. So, it is important to check NCCI edits before billing the claim to insurance for timely payment.
- Modifier 59 is very frequently used modifier in this scenario but be careful while using it with federal payers like Medicare. They have certain guidelines for how many modifiers 59 should be used in claim form.
- If services which are necessary for the patient and are unrelated with the service taken can be billed and reimbursed separately by adding supporting modifiers. For example, if a patient had undergone surgery. But during hospitalization the patients found suffering from other illness which is not related to surgery and is minor in nature, but the doctor addresses it. The physician visit will be denied as globally bundled. In this case modifier 24 can be used.
- Providers need to be fully aware of the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) guidelines under which cpt are bundled together.
Also read: Modifier