American Health Information Management Association (AHIMA) Certification Practice Exam

What coding violation occurs when a basic colonoscopy is reported with additional service codes?

1. Unbundling

2. Optimizing

3. Sequencing

4. Maximizing

The correct answer is: Unbundling

The correct answer is unbundling, which refers to the practice of using multiple codes to report separate components of a service that should be billed as a single comprehensive code. In the example of reporting a basic colonoscopy alongside additional service codes, this represents a situation where the procedure is being artificially separated into distinct components when it should instead be represented as a single bundled service. Health insurance payers typically have specific bundled codes that encompass all necessary aspects of a procedure. By unbundling, a provider may attempt to increase reimbursement by detailing each part of a procedure rather than adhering to the bundled approach. This practice can lead to overbilling and often results in compliance issues, as it misrepresents the services rendered. Other options like optimizing, sequencing, and maximizing don't relate directly to the coding process in this context. Optimizing typically refers to improving the coding process or billing efficiency rather than misreporting it. Sequencing usually pertains to the order in which codes are assigned, particularly when involving multiple diagnoses or procedures. Maximizing might imply attempts to increase revenue but does not specifically address the improper coding practice in question. Therefore, unbundling is the accurate term for the situation described.