Re: Unbundled claims for Workman's Comp Cases

[Steve Verno]

Workers comp coding is no different than coding for a claim to BCBS, Aetna or anyone else.

In some states, you have to read the workers comp provider manual for instructions.  It will tell you which year's CPT codes they accept. 

Here in Florida, for several years. we had to use the 1994 CPT codes but now it is the current codes.

We also follow NCCI edits and do not unbundle if NCCI shows the codes to be bundled or inclusive.

Unbundling may be permitted if your State WC law or WC Provider Manuals permit it. If your State WC abdes by NCCI, then you follow NCCI rules and do not unbundle.  Just because an NCCI CPT code has a modifier of 1 and says to use MOdifier of 59, that is still no guarantee of payment.  The carrier can also follow their own internal coding edits.