What coding practice involves assigning separate codes for individual tests when a combination code exists?

The practice of unbundling refers to the assignment of separate codes for individual tests or services when a single combination code is available that encompasses those tests or services. This approach typically occurs when a provider chooses to itemize each component of a treatment rather than using a single code that accurately reflects the entire procedure.

Unbundling can lead to inflated billing, as it often results in higher overall charges for the patient or payer. In many healthcare systems, unbundling is discouraged or prohibited since it can contribute to billing inaccuracies and is not in line with accepted coding practices. The correct application of coding guidelines encourages the use of combination codes when they are appropriate, as they simplify the billing process and ensure that providers are reimbursed fairly for the services rendered.

In contrast, bundling represents the use of a single code to cover multiple related services or tests. Overcoding refers to assigning codes that do not accurately reflect the services provided, usually leading to higher reimbursement than justified. Undercoding involves coding in a manner that results in lower reimbursement than what the provider is entitled to, often due to not capturing the full extent of services provided. Understanding these distinctions helps ensure accurate coding compliance and appropriate reimbursement.