What does it mean to bundle medical codes?

Answer 1

Each payor follows certain medical coding and billing guidelines. Many of them follow coding guidelines set by companies like Ingenix or Medicare and they use them for all lines of business. These guidelines determine which codes can be billed as separate and distinct procedures or which codes, if billed separately, should really have been bundled under a primary code.

Sometimes inexperienced coders unbundle procedures when billing and their claims are subsequently denied, because they should have been billed under a global code or a more appropriate primary code. Some individuals, however, habitually unbundle codes, especially those that can be unbundled if the medical record meets certain criteria, hoping to receiving higher reimbursement. Anti-fraud units within Medicare and Healthplans regularly audit and collect overpayments from providers who unbundled codes that did not have supporting medical record documentation.