Bundling Codes and Reimbursement

Question: We are a lab and run certain tests for dialysis patients that are denied as block-coded procedures. For example, if we bill for a cholesterol (82465) and triglyceride (84478) screen, one is paid and one is denied as block-coded. Is there a modifier that we can use to get reimbursement for both tests performed on the same day?

Answer: No, there is no modifier for such lab work. Procedure codes can support the -51 modifier, indicating that procedures may usually be done together but are separate in this case for some peculiar reason. But that doesn’t apply to the codes you gave me.

You need to look very carefully at the reasons for the denials you are receiving. I think you are saying that the two tests are being bundled. Make sure that’s it, and then ask your payers why they are denying the claims. (Some payers won’t cover these tests too frequently and thus deny, but that is another problem.)

If your concerns refer to Medicare, you can search for answers under CMS’s Correct Coding Initiative (CCI) rules and its fee schedule. The CCI lists Medicare’s rules for which codes are considered part of one another (like amputating a toe on the right foot and then amputating the foot) and which ones are mutually exclusive (like a cesarean and a hysterectomy performed on the same patient on the same day).

The codes 82465 and 84478 are not on these lists. So far so good. But they could still be bundled if the payer determines that both tests are not medically necessary.

You should also carefully review the codes you use and their associated literature. Both codes you mention are referenced in the CPT Assistant in the issues December 1999:2, March 2000:11, and February 2005:9. Take a look at these resources.