Medical coding is a detailed process of translating critical patient healthcare diagnoses, treatments, therapeutic services, and medical equipment into the standard ICD-10, CPT, and HCPCS codes that are used by the healthcare industry, insurance companies, and public health institutions. These codes serve as a universal language that makes for clear communication while also facilitating coverage and reimbursement for services.
Medical practices of every scale and discipline need to use the correct medical codes to accurately describe the services provided. This information is used to generate claims that are submitted to commercial insurance companies or public health institutions. This means that the provider needs to choose the correct CPT code for every diagnostic process, treatment procedure, and medical equipment used.
Third-party medical billing and coding services offer an additional layer of insulation to providers, as they have industry experts who review claims, and medical records to ensure that the most accurate code is selected to describe the service or procedure that the patient received. This goes a long way toward reducing delays due to missing information, claim rejections, or claim denials.
Another layer of complexity added to the process of coding is determining whether a patient/procedure should be billed as a single procedure using just a single code or if it should be billed separately. This can vary depending on the overriding medical coding rules. Sometimes it can be hard to determine if multiple procedures or therapeutic treatments for a patient should be “Bundled” together or if they should be “Unbundled” to be coded and billed separately.
Bundling is a medical billing technique where specific CPT or HCPCS Level II codes are billed together under one single code. Unbundling is often the more appropriate coding technique for times when two or more codes that might be used for a single procedure can be billed separately.
Though knowing when to bundle or unbundle can potentially influence medical billing accuracy. If you or a staff member in charge of medical billing at your practice accidentally makes the incorrect choice it can cause claim delays, rejections, or outright claim denials.
This can have a major impact on the consistency of your practice’s revenue stream. Not to mention taking time away from treating patients just to correct the coding error.
What Is Bundling in Medical Coding?
Bundling is a medical billing technique the provider uses to apply a single CPT code for describing separate, but related procedures performed during a single appointment or within a reasonably defined period of time. This type of bundled payment approach allows the provider or healthcare facility to receive a single payment for all the services performed to treat a patient in their care.
The Office of the Inspector General notes that unbundling is the appropriate coding method for times when “The billing entity uses separate billing codes for services that have an aggregate billing code.” Determining if a procedure or a series of procedures can be bundled largely depends on what services were provided.
Bundling often applies to a case where a second procedure is necessary to successfully complete the primary procedure for completion of the treatment plan. This might be something like an incision that was needed for a surgical procedure which might not be considered a separate procedure. Whereas a closure of the incision after a surgical procedure is a critical part of completing the surgery. Even though the incision and closure are included in the surgical codes.
What Is Unbundling in Medical Coding?
Unbundling is more commonly used for treatment plans that require multiple procedure codes which are billed as a group of procedures covered by a single comprehensive code. Often unbundling is the more appropriate technique if the other procedures require some sort of additional skill and additional time required to complete.
This might be a procedure where the closure of a surgical incision is necessary to complete the treatment plan, but it requires an extensive amount of time and special skills to complete. These additional services can then be unbundled or reported using separate codes as well as the appropriate modifier.
In a case where a secondary procedure needs to be carried out at the same time as a more complex primary procedure, the secondary procedure can’t be unbundled to be reported separately when submitting the claim. These secondary, incidental procedures often require minimal additional provider resources and generally aren’t considered necessary for completing the primary procedure.
This might be an appendectomy surgery that is deemed to be “Medically Necessary” and might be reported separately. Yet the final removal of an asymptomatic appendix would be considered an incidental secondary procedure if it occurred during another abdominal surgery.
The Centers for Medicare and Medicaid Services notes that certain procedural codes, or “Status B Codes” should always be bundled together anytime they are billed as part of the same claim with another procedure code.
Unfortunately, unbundling can be a major problem for payers and insurance companies that are always looking for red flags and medical coding errors. This includes times when codes are unbundled improperly. Oftentimes, these unbundled claims are perceived as attempted fraud, which can result in significant overpayments. Yet for the provider bundling services that should be unbundled can result in significant revenue loss.
Industry Bundling Guidelines for Accurate Medical Coding
The questions about bundling and unbundling are so common that the National Correct Coding Initiative has come up with guidelines for determining which is the correct case.
Services considered to be mutually exclusive, incidental to, or integral to the primary service rendered Should not be allowed additional payment.
Not all CPT or HCPCS Level II codes are subject to bundling. However, a single code could be subject to bundling might be bundled with dozens of codes.
Of course, there are exceptions to even these guidelines. Such as times when a specific code that’s normally bundled might be reported in a claim and reimbursed separately. Though this is only if the two procedures occur at separate anatomic sites, or during separate patient encounters.
The National Correct Coding Initiative also notes that any time a claim is unbundled, the correct modifier must be added to the code that is normally bundled. If the correct modifier isn’t used or is absent, most payers will automatically reject the code outright and deem it to not be separately payable.
How to Avoid Bundling & Unbundling Errors
One of the best ways to avoid bundling and unbundling errors when generating and submitting a claim is to partner your medical billing needs with an expert like Operant Billing Solutions. Our expert coders have extensive training and years of experience to know when codes should be bundled to be billed together or unbundled for separate billing. We then apply the correct modifiers and vet the entire claim before it’s ever submitted to an insurance carrier.