American Health Information Management Association (AHIMA) Certification Practice Exam

What error occurs when separate codes are assigned for procedures that should be coded together?

1. Maximizing

2. Upcoding

3. Unbundling

4. Optimizing

The correct answer is: Unbundling

The term used to describe the error that occurs when separate codes are assigned for procedures that should be coded together is known as unbundling. Unbundling refers to the practice of using multiple codes to describe a set of procedures that are typically billed as a single comprehensive procedure. This can unintentionally inflate the overall cost of care and can violate coding guidelines and payer policies. In healthcare coding, certain procedures are often included in bundled codes, which represent a complete service or treatment. When a coder unbundles these services, they may cause an overestimation of the complexity and cost of care provided, leading to potential audits or denials from insurers. Understanding bundling and unbundling is crucial for accurate coding and billing practices. The other terms reflect different issues in coding and billing practices. Maximizing typically refers to practices aimed at maximizing reimbursement within legal and ethical limits, while upcoding involves coding a procedure at a higher level than what was performed, potentially leading to fraudulent billing. Optimizing generally pertains to improving processes or systems but is not specific to coding errors.