Question

Which one of the following choices is a common error encountered with code linkage and medical necessity?A) Unbundling

B) Upcoding
C) Code linkage
D) Code mismatch

Answer 1

The common error encountered with code linkage and medical necessity is unbundling. Unbundling refers to the practice of submitting separate billing codes for procedures or services that should be billed together as a single code.

Step-by-step explanation:

The common error encountered with code linkage and medical necessity is unbundling. Unbundling refers to the practice of submitting separate billing codes for procedures or services that should be billed together as a single code. This can lead to inflated reimbursement and is considered fraudulent.

For example, if a patient receives a comprehensive examination which includes both a physical examination and laboratory tests, it should be billed as a single code that encompasses both components. However, if separate codes are submitted for the physical examination and each individual laboratory test, it would be considered unbundling.

Unbundling is a violation of coding guidelines and can result in financial penalties, legal action, and damage to the reputation of healthcare providers.