Moran determined that CMS' policy would advantage customers of the lowest-price biosimilars and penalize those whose sales prices were above the blended average sales price for each bundled code
However, when they are conducted together, the appropriate code should be 72158, which is the bundled code
. Unbundling and other deceptive practices will almost always be overlooked if a carrier is not using an effective bill review tool.
When the issue is use of a modifier or whether multiple procedures or a single bundled code
is more appropriate, often a respectful conversation with the medical director using documentation and evidence--such as CPT Assistant, Correct Coding Initiative rules, and specialty society policy advisories--will be successful.