Michael, a medical provider, performs an appendectomy but submits two codes for the same procedure. Which scheme best describes this behavior?

• A. Fictitious Services
• B. Unbundling
• C. Decompressing
• D. Procedure Compounding

Answer: (B)

Unbundling is at play here. When a single surgical procedure is performed, there’s usually one CPT code that describes the operation. Submitting two codes for the same surgery splits one service into parts to claim more payment, which isn’t allowed under coding rules. It’s considered improper billing and can trigger audits or recoupment by payers. In this scenario, the appendectomy should be coded with the single appropriate operative code unless there are clearly separate, independently billable components or stages with proper justification and modifiers. Fictitious services would mean reporting something that didn’t occur, while the other terms aren’t recognized billing schemes for this situation, so they don’t fit.