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Bundling of Laboratory Tests: Thyroid and Cholesterol
One of the common reasons denial, among claims submitted to Palmetto GBA, is 'bundling' associated with the National Correct Coding Initiative (CCI). Among the procedures denied for this reason are two CPT codes commonly submitted by independent clinical laboratories and physician office laboratories.
- 83721: Lipoprotein, direct measurement; LDL cholesterol. This procedure is bundled with several other laboratory CPT codes, including: 80061, 82465, 83700, 83701 and 83704.
- 84479: Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (TBHR). This procedure is bundled with laboratory CPT code 84439.
When are 'bundled' procedures reimbursed separately?
A bundled CPT code may only be reimbursed separately from the procedures of which it is a 'component' when it is a 'distinct procedural service' and is submitted with CPT modifier 59. Documentation must be maintained in the medical records to support the use of this modifier.
- Only bundled CPT codes with CCI indicator '1' may be reimbursed separately under these circumstances
- Bundled CPT codes with CCI indicator '0' are never reimbursed separately
Where are CCI indicators listed?
CCI indicators are listed on the CMS Web site and are updated quarterly. To access the CCI indicators, go to www.cms.hhs.gov/NationalCorrectCodInitEd/.
- Parent and component codes are classified as Column I/Column II codes
- CMS also maintains 'Mutually Exclusive Code' listings, comprised of codes that cannot be reimbursed together
Before submitting a claim for 'bundled' services:
- Check the CCI edit list on the CMS Web site. If you are performing a Column I and Column II code pair and:
- The Column II (component) code is listed with indicator '0,' do not submit a claim for the service. Reimbursement for this service is always included with the Column I (parent) code
- The Column II (component) code is listed with indicator '1,' you may submit a claim for the component only if it is a distinct procedural service, e.g., the service was performed during a separate patient encounter and was medically necessary. Submit CPT modifier 59 to indicate that the component code is a distinct procedural service.