What is the term for reporting several codes instead of one combination code?

The term for reporting several codes instead of one combination code is unbundling. This practice involves separating a set of related medical services or procedures that are typically billed under a single comprehensive code. Unbundling can lead to higher reimbursement because it allows providers to claim a higher total payment than they would receive from a singular code.

In medical billing and coding, combination codes are designed to streamline the billing process and more accurately reflect the scope of services provided. When providers unbundle, they may be utilizing multiple codes for what would normally be captured under one comprehensive code, which can lead to compliance issues if not justified. The practice can be scrutinized by payers, as it could be viewed as an attempt to manipulate billing for increased revenue.

Understanding unbundling is essential in the realm of healthcare compliance because it underscores the importance of accurate billing practices and adherence to coding guidelines to avoid fraud and ensure proper reimbursement. Being aware of such practices also highlights the need for compliance training among healthcare professionals involved in billing and coding.