How to Unbundle in Medical Coding

Special codes are used in the billing of health-insurance carriers for medical visits, supplies and services a patient receives. These procedure codes, generally four to five digits long, sometimes represent multiple services administered to a patient on the same day. Sometimes a single code will represent a single procedure, too.

A medical biller must make sure that codes for individual procedures are not included on a bill when the same procedure has been covered in a code for multiple procedures. Unbundling occurs when the procedures, services and supplies are listed with their own separate, distinct codes. Billers must go through procedures and regroup these unbundled codes to make sure they are grouped together properly.

Things You'll Need

• Patient Medical Chart
• CPT Procedure Book
• ICD-9 CM Diagnosis Book
• Coding software (optional)

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Instructions

• 1

  Identify the services and diagnosis provided to the patient by reading the medical notes or chart for the date of service.

• 2

  Look up the services and diagnosis in the CPT procedure and ICD-9 CM books to determine which procedures and diagnosis codes to bill for the date of service.

• 3

  Review the "bundled" procedure codes in the CPT procedure book to determine if any of the lab, surgery or medical service the patient received that day should be bundled into one code for multiple services. The bundled procedure codes are called "panel" in the procedure book. The panels will list all of the procedure codes that should be included in the one procedure code panel.

• 4

  Log on to coding software, such as Ingenix Encoding Software, if available, to make sure the procedure code identified for billing can be billed with the other procedure codes. The software can tell you if the procedures identified should be further bundled into one or more codes.

• 5

  Bill the health insurance carrier for the bundled procedure code.