• AMA bundling guidance. The American Medical Association's
guidance is less structured than the NCCI edits, meaning it's more
likely for providers to report CPT codes separately to increase reim-
bursement.
If you don't pay close attention to which method your payers use,
you could be coding incorrectly or leaving a significant amount of
reimbursement money on the table. Let's look at how these bundling
methods differ as well as the best practices your coders and billers
should use to get the most out of each.
Payer contracts
Accurate, efficient and profitable bundling is based on the payer con-
tract. Review your contracts with a fine-tooth comb, and make sure
coders and billers are acutely aware of which edits your payers fol-
low. Many facilities simply follow NCCI edits for all payers, regardless
of what an individual payer's policies state, as a precautionary policy
or form of under-coding. After all, if you're following strict, widely
accepted NCCI guidelines to the letter, there's little risk of up- or over-
coding. While there's nothing wrong with being safe, you could be
leaving a lot of money on the table if you follow this one-size-fits-all
approach to bundled payments.
For example, consider an arthroscopic rotator cuff repair (CPT
29827) performed with and an arthroscopic limited debridement of
superior labral tearing (CPT 29822). If the payer is using the NCCI
edits, the debridement of superior labral tearing (CPT 29822) would
be considered bundled if it was performed on the ipsilateral or same
shoulder as the rotator cuff repair. However, if the payer is following
AMA bundling guidelines, CPT 29827 and CPT 29822 can be reported
separately. In other words, you'll get reimbursed at a higher rate if you
go by the AMA guidelines.
F E B R U A R Y 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 2 5
