CODING DANGERS

Courtney Gatto

National Correct Coding Initiative

National

Correct Coding Initiative (NCCI)

Implemented by the American Medical Association

Developed in 1996 to promote correct coding and mitigate incorrect coding

that leads to inappropriate payments for outpatient physician services.

The NCCI tools help to prevent downcoding, upcoding, fragmenting, and

unbundlingof services and procedures.

All of these mistakes could delay the revenue cycle.

DOWNCODING AND UPCODING

Downcoding,

also referred to as undercoding, is reporting a code

that represents a lower level of service or a less extensive
procedure than what is supported by the documents.

Downcoding

could result in underpayment.

Upcoding,

also referred to as overcoding, is reporting a service or

procedure that is more extensive than what the documentation
supports.

Upcoding

could result in overpayment.

UNBUNDLING AND FRAGMENTING

Unbundling

occurs when multiple CPT codes are reported when

there is a single code that represents the complete procedure.

The

single code that represents more than one procedure is called

a combination code.

There

may be some circumstances where unbundling a

combination code is acceptable.

Unbundling

could result in overpayment.

Fragmenting,

commonly referred to as unbundling, is separately

services inherent in a procedure or in a group of procedures.

RESOURCE
Berger, Ruth. Deciphering Procedural Coding. Place of
Publication Not Identified: Paradigm, 2015. Print.