What is another term for unbundling in coding fraud?

• A. Coding fragmentation
• B. Upcoding
• C. Missing documentation
• D. Fictitious services

Answer: (A)

Unbundling fraud involves billing separate codes for components of a procedure that should be covered by a single bundled code. This fragmentation of the service into multiple codes inflates reimbursement, which is why it’s described as coding fragmentation. In practice, you’d see a service that should be coded with one comprehensive code instead split into several codes for its parts to gain more payment. Upcoding, missing documentation, and fictitious services describe different fraudulent behaviors: upcoding uses higher-paying codes than warranted, missing documentation is a lack of necessary records, and fictitious services are billing for services never performed. So the term that best fits unbundling is coding fragmentation.