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Unbundling codes

You are a billing and coding specialist in a busy ophthalmology practice. A coworker told you that if you use the practice of unbundling codes when billing, you can create more revenue for the practice.

o What is meant by unbundling codes?
o Is this a legitimate way to create more revenue? Why or why not?

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Unbundling means to separate (Merriam-Webster dictionary). It is when a procedure that consists of various steps/components, is billed for each of the components or steps even though there is a code that describe this procedure. The best example of this practice is billing for blood work that is included in a chemistry 24 panel code. The individual 24 (approx) elements are billed (potassium, sodium, cholesterol, etc.), or billed for two individuals test and bill the others as chem. 24 in an effort to procure higher payment from the insurance.

Another example related to ophthalmology practice could be when the doctor has seen an establish patient that came for an ophthalmological check up, had a test like the visual field and a quick evaluated by the medical assistant for the eyesight. Since the evaluation required additional time from the provider, the biller used the Evaluation and Management Services (E/M) code 92014 "Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, ...

Solution Summary

The solution involves describing the use of unbundling codes including when it is considered fraud. Discusses situations that can come up in an ophtalmologist office billing.