Radiology Coding Alert

Question: I'm new to coding and I feel that I hear the word "unbundling" used in different ways by different people. Would you clear up what unbundling really means?


Massachusetts Subscriber
Answer: You've got at least four definitions of unbundling you need to remember:

1. Column 1/Column 2: When most people refer to unbundling, they mean coding for two procedures listed by the National Correct Coding Initiative in a column 1/ column 2 edit. You append a modifier to the less extensive code to tell the payer you deserve payment for both codes. The column 2 code is typically considered integral to the more extensive column 1 code, so payers will only pay you for the column 1 code.

Example: The NCCI edits tell you not to report column 2 code 36000 (Introduction of needle or intracatheter, vein) with column 1 code 70010 (Myelography, posterior fossa, radiological supervision and interpretation). Only report the column 1 code unless the procedures are distinct and separate (for example, performed during different encounters or on different parts of the body).
 
2. Mutually Exclusive Procedures: NCCI also releases lists of mutually exclusive procedures - studies you can't reasonably perform on the same day. Payers will only cover the less expensive procedure if you incorrectly unbundled these edits. Example: You can't report 77431 (Radiation therapy management with complete course of therapy consisting of one or two fractions only) and 77427 (Radiation treatment management, five treatments) for the same patient on the same day.
 
3. Fragmenting: If one service should be reported with one code, reporting a code for each of the components of the procedure is fragmenting. This can result in denials and allegations of fraud. Example: You report four separate chest x-ray codes and a fluoroscopy code instead of 71034 (Radiologic examination, chest, complete, minimum of four views; with fluoroscopy).

4. Unilateral Twice Instead of Bilateral: When your radiologist performs a bilateral procedure, always check your CPT manual for a bilateral code before simply reporting a unilateral code two times. Example: Instead of reporting two units of 75840 (Venography, adrenal, unilateral, selective, radiological supervision and interpretation), check your options and move down the page to 75842 (... bilateral ...).