Question:
I received my determination letter back from my insurance company.

The Gastric Bypass CPT43846 is approved as medically necessary. CPT4382 is denied as it is unbundled from CPT43846. What does this mean? Am I approved or not? Help....    — Tiffany C. (posted on August 13, 2003)

August 13, 2003
Call your MD's office and speak to their insurance expert. They should be able to figure out what the h#$l that means!
   — NJChick

August 13, 2003
When surgeons bill, they are supposed to choose a code that includes as many of the procedures as they can in one choice. The smaller procedures that make up the big picture are said to be "bundled" into the main code. If a surgeon wants to bill separately for each small portion of the surgery they are said to be choosing to "unbundle" and this is not allowed. This doesn't mean the insurance company is correct automatically - sometime the insurance companies and the surgeons disagree on what should be included in the codes automatically, but that in the insurance company's opinion the payment for 43846 is supposed to include payment for 4382 (but this is only 4 digits long so there is a typo somewhere). There are some procedures that include others, and some that do not. Since the "unbundled" code is not valid (only 4 digits long) I can't look it up to tell you what the procedure they wanted to bill for additionally was. So, you are approved for the bypass, but you should ask your surgeon's office what they were trying to get approved separately and see if it was their error for submitting the extra code, or if this is something separate that needs to be straightened out and is a valid charge.
   — bethybb

August 13, 2003
Hi Tiffany- Was that insurance letter written in English? LOL It sounds like you're approved for something :o) I would call your insurance or HR dept and ask what is a CPT43846 and what is a CPT4382. The word "unbundled" makes me think it's something that may be considered experimental by the insurance co, I believe some people have mentioned LAP or that robotic hand device as experimental? (at least by insurance co. standards). Or "unbundled" could mean in addition to the WLS? Gall Bladder removal? Could you post again when you find out, I'm really curious to know what the heck that meant. It sounds like something from Star Wars, LOL. Good Luck! Mea
   — Mea A.

August 14, 2003
Beth is correct. Not that your surgeon is doing this...but here is an example: Surgeon bills for the gastric bypass using the cpt code above...then at the same time bills for stapling you back up. One is expected to be included with the other. Certain CPT codes include several other codes. So to bill the global cpt and the individual one is in turn, billing it twice. BTW..congrats on your approval! :)
   — RebeccaP

August 14, 2003
What some of the other posters said is correct about the bundling. An example of billing two legitimate separate procedures is: WLS and placement of a G-tube. Since the G-tube is not normally required for WLS it is billed as a separate code secondary to the WLS. Both of mine were paid in full. Congrats! You are going to get your WLS!!!
   — zoedogcbr