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Revised Bundling Guidelines for BCBS of North Carolina

Hernia repair (43280, 43281, 43332, 43334, 43336) is considered an incidental procedure when performed during the same operative session as bariatric surgery (43644, 43645, 43770, 43775, 43842, 43843, 43845, 43846, 43847). Modifiers 58, 59, 78 and 79 (or XE, XS, XP, XU) will not allow additional payment when appended to these codes. 

Chemotherapy – Evaluation and Management services will generally be denied when submitted on the same date of service as a chemotherapy administration code. If a significant, separately identifiable service is performed, modifier 25 is used. Office notes must document the significant, separately identifiable service. 

Obstetrical ultrasound: 

Ultrasound add-on codes indicating multiple gestation will be denied when the diagnosis code does not specify multiple gestation. 

First trimester obstetrical ultrasound (76801) is considered to be incidental to obstetrical ultrasound with first trimester fetal nuchal translucency measurement (76813) unless there is a separate medical necessity indication for 76801. 

Office visit (99211) is considered mutually exclusive to 95115-95117 (allergen immunotherapy) and not eligible for separate reimbursement. 

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