Dangerous, is the short answer.
Upcoding is assigning a more difficult code (a code that carries a higher reimbursement) than what was actually performed. According to the OIG (Office of the Inspector General) this is one of the top red flags in the industry.
If an office visit has a description that specifically states 15-20 minutes of face to face time with the patient, and you spend 5 minutes or less, you are not coding properly. Also, if you do spend 20 minutes with the patient, but you charge the code that states 45 minutes of face-to-face time with the patient, you are doing the same thing.
If you charge for a New Patient Evaluation, but it is not a new patient, you can get nailed.
Upcoding is nothing to fool around with. It is considered Fraud by both Government Agencies, and private insurance companies. They will not hesitate to report you if they see a pattern with your billing.
When assigning codes, especially E&M codes, it is essential that all elements are met exactly as described. Take the extra time to make sure this happens. Otherwise, your Christmas may not be so merry.
Until next time:
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Author, Medical Billing, Coding, and Reimbursement
A medical billing professional for over 30 years now, I have seen a lot of changes in this field, and there are a lot more on the horizon. Follow me as we see what they mean and for who.