With constantly changing CDT codes and insurance requirements, dental billing and coding can be daunting. Fortunately AI-powered, tech-driven dental billing services provide accurate, compliant, and efficient solutions to streamline claims and improve revenue. Unbundling is one of the most common dental billing errors. This post explains common examples of unbundling in dental billing and offers practical tips to avoid this costly mistake.
What is Unbundling in Dental Billing?
Unbundling in dental billing occurs when a dentist bills multiple, separate codes for services that have a single, comprehensive code. The total charge for multiple separate service codes would be higher than the charge for a single comprehensive code. The American Dental Association (ADA) and insurance companies consider unbundling as fraud as a form of overcharging done to increase payment.
Unbundling happens when a single procedure is fragmented into its individual components and each one is billed separately. Several codes are submitted to report the service when one code is sufficient to capture the entire service, according to the current ADA dental code set. Here are three examples provided by the ADA of what is considered unbundling in dental coding:
- Reporting pins as a separate service from a core buildup (the D2950 buildup code includes pins);
- Reporting suture removal as a separate service from the extractions, which include suturing and postoperative care: Codes for extractions (like D7140, D7210, D7230) already include suturing and post-operative care. Billing suture removal separately would be considered unbundling and could lead to claim denial, and
- Reporting X-rays taken during the course of root canal therapy as a separate service from the root canal, which by definition, includes intra-operative X-rays: For example, D3310 – Endodontic therapy (molar root canal therapy on a molar) includes any pre-operative, intra-operative, or post-operative X-rays required to complete the root canal. Reporting the X-rays separately would be considered unbundling.
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So how common are dental billing unbundling errors?
A dental claims case study conducted by AAPC Services between January and December 2023 revealed notable unbundling errors and highlighted the need for improvement in coding and documentation practices. The audit covered 10 population and community health centers, reviewing 260 providers and 2,600 claims. Findings showed a 79% CDT coding accuracy rate, with 14% of claims containing coding errors primarily due to insufficient documentation, unbundling, and overcoding. Key findings of the survey with regards to unbundling:
- Radiologic Images (31% Errors): Errors involved unbundled radiologic images or inadequate documentation supporting the billed number of films and their medical necessity. Commonly misused CDT codes included:
- D0210: Intraoral – complete series of radiographic images
- D0330: Panoramic radiographic image
- D0230: Intraoral – periapical each additional radiographic image
- D0272: Bitewings – two radiographic images
- D0220: Intraoral – periapical first radiographic image
- D0277: Vertical bitewings – 7 to 8 radiographic images
- D0274: Bitewings – four radiographic images
- D0270: Bitewings – single radiographic image
- D0350: 3D photographic image
- D0367: Cone beam CT image capture with interpretation
- Procedural Errors (32% Errors): Unbundling and insufficient documentation of procedures errors were found in:
- Intraoral placement of fixation device (re-cement or re-bonding, sealant repair) performed within the same time limitation
- Tooth extractions
- Protective restoration
- Resin-based composites
- Crowns
Adopting comprehensive coding practices that accurately reflect the services provided is essential to avoid unbundling errors.
Consequences of Unbundling
Unbundling in dental billing can significantly affect insurance reimbursement and the financial health of a dental practice.
- Denials: When procedures that are meant to be billed as a single comprehensive service are submitted as separate codes, payers often identify them as unbundled, resulting in partial or denied payments. This not only reduces the expected reimbursement but can also trigger audits, increase administrative workload, and delay revenue collection.
- Compliance issues: Unbundling can be seen as fraudulent and can lead to audits or penalties, especially if it’s done intentionally to increase payments. Repeated unbundling errors can affect the practice’s credibility and eligibility for certain insurance programs.
- Increased administrative work: Claims may be denied, requiring the practice to resubmit them, which costs time and money.
- Recoupment: In some cases, an insurer might mistakenly pay for all the unbundled codes, but they are entitled to demand recoupment when the error is detected.
Ensuring accurate coding and proper documentation is essential to maintain smooth claims processing and optimize reimbursement.
How to Avoid Unbundling Errors in Dental Billing
- Ensure Accurate, Comprehensive CDT Coding
Choose the most appropriate single code that covers all the services performed. For e.g., a dentist performs a full-mouth periodontal evaluation, including: charting pocket depths, assessing gingival inflammation, and evaluating bone levels via X-rays
The correct single comprehensive code for this service is: D0180 – Comprehensive Periodontal Evaluation
Incorrect coding or unbundling would occur if the dentist reports separate codes for comprehensive periodontal evaluation, periodic oral exam and bitewing X-rays.
Choosing the single appropriate code ensures compliance, prevents claim denials, and maximizes accurate reimbursement.
- Stay Updated on CDT Codes
The ADA updates CDT codes annually. It’s crucial for dental practices to stay vigilant and ensure CDT coding compliance by using the current codes. For example, to simplify the documentation and reporting of interim restorations, the nomenclature for D2940 “placement of interim direct restoration” was revised in CDT 2025 from “protective restoration” to “placement of interim direct restoration.
Based on its revised descriptor, code D2940 now serves as a single code to capture the placement of any restorative material as an interim direct restoration using any method.
Code D2941 interim therapeutic restoration was deleted.
Not staying updated on annual code changes can lead to missing these changes and incorrect coding.
- Understand Payer Rules
Familiarize yourself with the specific bundling rules of the insurance plans your practice participates in. What is considered unbundling or non-reimbursable under one plan may be allowed under another. Familiarity with these rules helps avoid denied claims and ensures maximum reimbursement.
- Conduct Billing Audits
Regularly reviewing your billing processes can catch unbundling mistakes and other errors, helping your practice get paid correctly and on time.
- Review Claims before Submission
Always double-check your claims before sending them to insurance to catch mistakes, correct them, and ensure appropriate reimbursement.
Avoid Overcoding and Unbundling in Dental Documentation with Expert Support
Unbundling in dental billing can lead to claim denials, reduced reimbursement, and compliance risks for your dental practice. By ensuring accurate documentation, following CDT coding guidelines, and avoiding overcoding, you can minimize these costly errors. Working with an expert AI and technology-driven dental billing company is a smart approach to ensure coding and billing compliance, streamline claims processing, and protect revenue. With specialized support, dental practices can stay audit-ready, optimize reimbursement, and maintain smooth, compliant billing workflows.
AI-driven dental billing solutions can streamline your workflow and maximize reimbursement.
Amber Darst is our Solutions Manager in the Healthcare Division, Practice and RCM. She is CPC certified by the American Academy of Professional Coders (AAPC). With a rich background in dental services, her expertise ranges from insurance coordination to office management.
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