Do You Report Separate Codes for Separate Excisions?

One daily dilemma that many in the medical billing industry face are
when to bundle a claim for services rendered and group like services and when to report them separately.

Ultimately you want fair reimbursement for all services rendered to patients and with the fee structures for repayment on medical billing claims, it can be confusing about when exactly to combine and when to split services out as individual procedures.

A good example would be if a physician debrides two sites with infected decubiti, technically, it would be two procedures and in most cases could be reported as separate. A good rule of thumb would be to first look at the decubiti excision codes (15920-15999). Select a code according to the ulcers’ location and whether the physician also performs ostectomy (bone removal) or primary suture.

Generally, you may report each excision separately, and you may also report free skin grafts (15000-15261) if the physician uses a graft to close the wound or donor site. Because the physician is working in the same general area of the body doesn’t mean the claim needs to be automatically bundled. In many cases the procedures can be legitimately reported as two separate services and reimbursed as such.

If you’re tired of keeping up with when to bundle, when not to and all the cancelled and new codes that keep this industry moving at a fast pace, consider it might be time to outsource your medical billing and let them have the headaches of the paperwork and you do what you do best – service your patients and grow your practice.

View all Articles by: Kathryn E, CCS-P - Retired