Rlcj pg wcs lv trnsmtr only — 59 bundling rules
If your bill lists 0863T alongside any of these codes as separate charges, it may be an unbundling error.
About the analyst
Kevin Nyk analyzes hospital pricing data at BillRazor Research. He specializes in Medicare reimbursement patterns and chargemaster pricing across U.S. hospitals. Expertise: hospital pricing, Medicare rates, chargemaster analysis.
Common unbundling errors — Other procedures
Unbundling occurs when medical providers bill two separate codes for services that should be combined into a single charge according to National Correct Coding Initiative (NCCI) rules. In other procedures including anesthesia, radiology, pathology, and miscellaneous support services, common unbundling patterns include separately billing diagnostic imaging with its professional interpretation when both should be included in one comprehensive code, and charging for basic monitoring or preparation services alongside the primary procedure when these components are considered integral parts of the main service. Another frequent error involves billing multiple pathology examination codes for what constitutes a single comprehensive analysis. With 809 other codes subject to bundling restrictions in the NCCI database, these errors create charges above the benchmark for patients who receive multiple bills for what should constitute one complete service. The potential difference between unbundled billing and correct coding practices can significantly impact patient financial responsibility, as they may face duplicate charges for components of care that medical coding standards define as a single billable service.
What to check on your bill
When reviewing itemized bills for procedure bundling issues, patients should examine several key areas to identify potential billing irregularities. Look for multiple procedure codes billed on the same date that represent components of a comprehensive service, such as separate charges for incision, repair, and closure when these steps are typically included in one primary procedure code. Watch for code patterns where related procedures share the same first three digits, as these often indicate services that should be bundled together under Medicare's Correct Coding Initiative. Check for appropriate modifier usage, particularly modifier 59 or XS, which legitimately allow separate billing when procedures are performed on different anatomical sites or during distinct sessions. Without proper modifiers, separately billed related procedures may represent charges above the benchmark. Compare your itemized statement against standard bundling practices for your specific procedure type to identify potential differences in billing patterns.
All bundling rules for 0863T
59 code pairs that have billing restrictions with this procedure.
| Code | Description | Rule |
|---|---|---|
| 0522T | Prgrmg dev eval wcs ip | Never bill together |
| 0861T | Rmvl pg wcs lv both compnt | Never bill together |
| 11000 | Dbrdmt ecz/infected skin<10% | May bill with modifier |
| 11004 | Dbrdmt skin xtrnl gent&per | May bill with modifier |
| 11005 | Dbrdmt skin abdominal wall | May bill with modifier |
| 11006 | Dbrdmt skin xtrnl gent per | May bill with modifier |
| 11042 | Dbrdmt subq tis 1st 20sqcm/< | May bill with modifier |
| 11043 | Dbrdmt musc&/fsca 1st 20/< | May bill with modifier |
| 11044 | Dbrdmt bone 1st 20 sq cm/< | May bill with modifier |
| 35231 | Repair blvsl vn grf neck | May bill with modifier |
| 35236 | Repair blvsl vn grf uxtr | May bill with modifier |
| 35241 | Rpr blvsl vn grf ntrthrc w/b | May bill with modifier |
| 35246 | Rpr blvsl vn grf ntrthrc w/o | May bill with modifier |
| 35251 | Rpr blvsl vn grf intra-abdl | May bill with modifier |
| 35256 | Repair blvsl vn grf lxtr | May bill with modifier |
| 35261 | Rpr blvsl grf oth/thn vn nck | May bill with modifier |
| 35266 | Rpr blvsl grf oth/th vn uxtr | May bill with modifier |
| 35271 | Rpr blvs gr ot/th vn ntrth w | May bill with modifier |
| 35276 | Rpr blvs gr ot/t vn ntrth wo | May bill with modifier |
| 35281 | Rpr blvsl gr ot/th vn ntr-ab | May bill with modifier |
| 35286 | Rpr blvsl grf oth/th vn lxtr | May bill with modifier |
| 36591 | Draw blood off venous device | Never bill together |
| 36592 | Collect blood from picc | Never bill together |
| 76000 | Fluoroscopy <1 hr phys/qhp | May bill with modifier |
| 76998 | Us guide intraop | Never bill together |
| 93303 | Echo transthoracic | Never bill together |
| 93304 | Echo transthoracic | Never bill together |
| 93306 | Tte w/doppler complete | Never bill together |
| 93307 | Tte w/o doppler complete | Never bill together |
| 93308 | Tte f-up or lmtd | Never bill together |
| 93312 | Echo transesophageal | Never bill together |
| 93313 | Echo transesophageal | Never bill together |
| 93314 | Echo transesophageal | Never bill together |
| 93315 | Echo transesophageal | Never bill together |
| 93316 | Echo transesophageal | Never bill together |
| 93317 | Echo transesophageal | Never bill together |
| 93318 | Echo transesophageal intraop | Never bill together |
| 93319 | 3d echo img cgen car anomal | Never bill together |
| 93320 | Doppler echo complete | Never bill together |
| 93321 | Doppler echo f-up/lmtd std | Never bill together |
| 93325 | Doppler echo color flow mapg | Never bill together |
| 93350 | Stress tte only | Never bill together |
| 93351 | Stress tte complete | Never bill together |
| 93352 | Admin ecg contrast agent | Never bill together |
| 93355 | Echo transesophageal (tee) | Never bill together |
| 93452 | Left hrt cath w/ventrclgrphy | Never bill together |
| 93453 | R&l hrt cath w/ventriclgrphy | Never bill together |
| 93458 | L hrt artery/ventricle angio | Never bill together |
| 93459 | L hrt art/grft angio | Never bill together |
| 93460 | R&l hrt art/ventricle angio | Never bill together |
Showing 50 of 59 rules. Show all
FAQ — Other procedure bundling
What is NCCI bundling and what does 'bundled' mean on a medical bill?
How can I identify if codes were incorrectly unbundled on my bill?
What should I do if I find unbundled charges on my medical bill?
When is it legitimate to use modifiers to override NCCI bundling rules?
Data source: CMS National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits, updated quarterly. These code pairs are maintained by CMS to prevent improper billing of services that should be billed as a single procedure.
What this means: When two codes are listed as an NCCI edit pair, billing them separately on the same date of service is typically incorrect. "Never bill together" means no modifier can override the rule. "May bill with modifier" means the codes can be billed separately with appropriate documentation.