A medical provider bills separately for a comprehensive metabolic panel and a quantitative glucose test, which is normally included in the metabolic panel. This is an example of which of the following fraudulent coding and billing practices?
A) Reporting services that were not performed
B) Reporting services at a higher level than was carried out
C) Performing procedures not related to the patient's condition
D) Billing separately for services that are bundled in a single procedure code
E) Reporting the same service twice

Question

Quizplus · Accepted Answer

Billing separately for services that are bundled into a single procedure code, such as billing a comprehensive metabolic panel and a quantitative glucose test separately when the glucose test is included in the panel, is known as "unbundling" or "fragmentation." This practice is considered fraudulent because it can lead to higher costs for patients or insurance providers.

A Medical Provider Bills Separately for a Comprehensive Metabolic Panel