• How to Know When You Can Unbundle

    Question:  What is the path to unbundling? How is it determined?

    Answer: Bundling is defined as including one procedure with a unique CPT or HCPCS code in a more extensive procedure performed at the same time. The National Correct Coding Initiative (NCCI or, more commonly, CCI) publishes these bundles quarterly. The Academy maintains an overview of the latest ophthalmology-related edits on its website.

    It is only appropriate to unbundle the two CPT codes when the procedure is:

    • A different encounter;
    • A different anatomic site; or
    • A distinct service.

    The primary purpose of modifier -59 Distinct procedural service is to appropriately unbundle CCI edits. Use of this modifier is so prevalent that CMS in August 2014 announced four new HCPCS modifiers to define specific subsets of modifier -59:

    • -XE Separate encounter;
    • -XS Separate structure;
    • -XP Separate practitioner;
    • -XU Unusual non-overlapping service.