Generally, ‘bundled’ codes refer to procedure codes for less extensive exams being included in (or bundled with) procedure codes for more extensive exams being performed at the same anatomic location, or site.
For most CT scans, three separate CPT® code choices are available based on the site being studied: without contrast, with contrast and without and with contrast; where without and with contrast is considered the most extensive exam. For example:
74150 CT, abdomen; without contrast material
74160 CT, abdomen; with contrast material(s)
74170 CT, abdomen; without contrast material, followed by contrast material(s) and further sections
Unbundling refers to charging multiple CPT codes when a single, more extensive option exists. Per the NCCI Policy Manual for Medicare Services, Chapter IX, Section A: “A physician shall not report multiple HCPCS/CPT codes if a single HCPCS code exists that describes the services. This type of unbundling is incorrect coding.”
In the case of CT scans, the site-specific codes for without, with and without and with contrast should not be reported together when performed at the same encounter. This would fall into the territory of unbundling. As an example, for the above CT abdomen codes this would be reporting 74160 and 74170 together.
These rules are not new and shouldn’t be a surprise to anyone familiar with radiology CPT codes. So, why are we talking about this?
In February of 2019, the Centers for Medicare & Medicaid Services (CMS) Recovery Audit program announced that they would be auditing, and recovering overpayments for, unbundled CT scans. Per the release from CMS:
“This query identifies multiple units of CT scans billed on the same day by the same provider for the same beneficiary. The most extensive code should be the only code paid. The less extensive CT scan code(s) will be recovered as overpayments.”
See the list of codes being affected here →
With CT scans among the most common diagnostic imaging services performed, one mis-applied code has the potential to add up to a large financial impact. With recovery audit attention, it’s worth a second look to verify codes are being reported appropriately.
To ensure the proper code(s) are assigned for CT scans, each report needs to tell what was imaged and, more importantly, how it was imaged. There are five key elements that should be included in each report:
For a monthly review of news, risk areas and potential compliance issues specific to radiology, check out our Radiology Compliance Manager newsletter to provide your team with the information and education they need to navigate through the ever-changing landscape that is radiology services.
You get the same trusted expertise in all of our radiology coding books. Plus, save up to $137 when you bundle your resources. Choose from two coding suites:
ESSENTIALS Radiology 3-Part Coding Suite
Includes the following books: CT/MR Coder, Breast & Bone Density Coding Guide and Ultrasound Coder
COMPREHENSIVE Radiology 5-Part Coding Suite
Includes the books in our Essentials suite, plus Interventional Radiology Coder and Nuclear Medicine & PET Coder
Here at MedLearn, we know cardiology coders are the unsung heroes of patient care. Every day, as a cardio coder you navigate complex cardiovascular procedures, including the constantly –changing CPT® and ICD-10-CM
Today, we are continuing our January look at 2026 CPT code updates. As a reminder there were 5,933 new CPT codes with the January 1
Please log in to your account to comment on this article.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
