Health Information Management

Tip: Differentiate between packaged, bundled services

APCs Insider, November 11, 2011

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Packaging is different from bundling—bundling is a coding concept, whereas packaging is a payment concept.

With bundling, coders only report the most comprehensive code and don't report the subsequent code(s) on separate lines of the bill.

NCCI edits specify which codes are bundled codes, and under normal circumstances, coders should not separately report codes for these services. The charges for these services should be reported as part of the charge for the bundled code, or they may appear separately on an appropriate revenue code line without a HCPCS code.

Packaging is very different. Hospitals generally report the packaged services, but do not receive a separate payment for these services because they receive payment as part of other separately paid services reported on the same claim. For example, although recovery services are billed separately on a claim, CMS packages them into the payment for surgery.

To illustrate an example of packaging, payment for a surgical CPT ® code includes:

  • Surgical time and supplies
  • Covered drugs
  • Implantable devices
  • Recovery time
  • Observation time

Unlike bundled items and services, packaged items and services may—and sometimes must—be reported separately on the claim with a HCPCS code. Packaged services generally have status indicator N, but they may also have status indicators Q1 or Q2. Items or services separately payable under OPPS have status indicators G, H, K, P, Q3, R, S, T, U, V, or X.

The tip is adapted from “Correctly count observation time for outpatients” in the August Briefings on APCs.



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