Upcoding is the practice of using a code that inaccurately represents a higher level of service than what was actually provided in order to receive higher reimbursement. This is illegal and unethical. Downcoding, on the other hand, involves coding a procedure or service at a lower level than was actually performed. Modifier usage and bundling/unbundling refer to other aspects of coding but are not relevant to the definition of upcoding.
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What are the consequences of upcoding in medical billing?
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How does downcoding differ from upcoding?
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What are modifiers and how do they relate to coding practices?
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This question's topic:
AAMA Certified Medical Assistant (CMA) /
Administrative
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