What is bundling and unbundling in medical coding

When two procedures should be bundled in a single CPT code, coders who bill the two procedures separately using two CPT codes are unbundling the procedures. Unbundling also occurs when a coder charges for two services when the code for the major service assumes that the minor service is also provided.

What is bundling in coding?

What is Bundling? When a payer bundles codes, it combines two or more codes into one. Doing so allows them to replace two codes with one overarching code and pay the provider only for the amount allowed under the more dominant code.

What is the difference between unbundling and bundling?

Unbundling. Bundling is the process of combining multiple products or services within a unique offering. Unbundling is the opposite; it consists of taking one part of an offering (often the most valuable) and provide it as a stand-alone product and service at a more reasonable price.

What does unbundling mean in medical terms?

WHAT IS UNBUNDLING? Unbundling is a form of medical billing fraud that is similar to upcoding. In unbundling, medical providers bill complex, multi-step procedures separately, instead of as one coded procedure. Billing the steps individually allows the provider to recover more reimbursement for the same services.

What does bundling mean medical term?

A payment structure in which different health care providers who are treating you for the same or related conditions are paid an overall sum for taking care of your condition rather than being paid for each individual treatment, test, or procedure.