Back to Basic: All the Ways (Not) to Unbundle

Coders learn early and are reminded often to avoid unbundling, or separately reporting procedures/services that are meant to be reported together, using a single code. As the introduction of the National Correct Coding Initiative (NCCI) Policy Manual explains, “Procedures should be reported with the most comprehensive CPT® code that describes the services performed.” To make the point clear, the policy manual provides examples of all the ways you shouldn’t unbundle:

A physician should not report multiple HCPCS/CPT codes when a single comprehensive HCPCS/CPT code describes these services. For example if a physician performs a vaginal hysterectomy on a uterus weighing less than 250 grams with bilateral salpingo-oophorectomy, the physician should report CPT code 58262 (Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s)). The physician should not report CPT code 58260 (Vaginal hysterectomy, for uterus 250 g or less;) plus CPT code 58720 (Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)).

A physician should not fragment a procedure into component parts. For example, if a physician performs an upper gastrointestinal endoscopy with biopsy of the stomach, the physician should report CPT code 43239 (Upper gastrointestinal endoscopy …; with biopsy, …). It is improper to unbundle this procedure and report CPT code 43235 (Upper gastrointestinal endoscopy …; diagnostic, …) plus CPT code 43600 (Biopsy of stomach; …). The latter code is not intended to be utilized with an endoscopic procedure code.

A physician should not unbundle a bilateral procedure code into two unilateral procedure codes. For example if a physician performs bilateral mammography, the physician should report CPT code 77056 (Mammography; bilateral). The physician should not report CPT code 77055 (Mammography; unilateral) with two units of service or 77055LT plus 77055RT.

A physician should not unbundle services that are integral to a more comprehensive procedure. For example, surgical access is integral to a surgical procedure. A physician should not report CPT code 49000 (Exploratory laparotomy,…) when performing an open abdominal procedure such as a total abdominal colectomy (e.g., CPT code 44150).

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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