AHA Coding Clinic® for HCPCS - 2015 Quarter 4
Bundling/unbundling caution is essential for accurate coding and reporting
Bundling is defined as the inclusive grouping of codes related to a procedure when reporting and submitting codes to the payer for medical services rendered. Some codes, by nature, are included in other codes that describe a more comprehensive service, which encompasses the lesser procedure. In reimbursement systems the more comprehensive code is valued at a rate that includes the lesser procedure, so it becomes inappropriate to report both codes. Reporting multiple CPT or HCPCS codes when a single comprehensive code describes the service(s) provided is referred to as “unbundling.” The Centers for Medicare & Medicaid Services...
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Article Overview
This article explains how bundling and unbundling affect medical coding and claim reporting, especially under CMS’s National Correct Coding Initiative. It is aimed at coders, revenue cycle staff, and others responsible for CPT and HCPCS reporting who need a high-level understanding of bundled services, PTP edits, and related modifier use in general terms.
Why This Topic Matters
Incorrectly separating or combining services can lead to inaccurate claims and reporting issues. Understanding the general framework behind bundling and correct coding helps support cleaner submissions and better compliance with payer edit systems.
Article Sections
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Bundling edits
Introduces the history and general purpose of bundling edits within the National Correct Coding Initiative. It also describes how CMS organizes correct coding edits and the broad types of code pair relationships addressed by those edits.
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CPT’s designation of “separate procedure”
Discusses the role of the CPT separate procedure designation and how it relates to inclusive services. The section also notes the general circumstances under which a modifier may be relevant in the context of NCCI edits.
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Unbundling
Covers the concept of unbundling as a reporting problem and outlines broad practices to avoid when assigning codes for comprehensive services. It also includes general reminders about bundled services, modifier use, and checking Medicare edit resources.
What You Will Learn
- How bundling and unbundling are described in medical coding
- How CMS’s NCCI framework relates to code pair edits
- The general meaning of CPT separate procedure designations
- Why some services are considered part of a more comprehensive procedure
- What broad documentation and reporting cautions are emphasized for coders
Who Should Read This
- Medical coders
- Revenue cycle staff
- Billing staff
- Compliance personnel
- Coding educators
- Healthcare administrators
Codes Discussed
Modifiers Discussed
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