What does the term 'upcoding' refer to?

Upcoding refers to the practice of using a higher service code than what was actually provided or performed. This can occur when a healthcare provider deliberately assigns a more expensive or complex code for a service in order to receive a higher reimbursement from insurance companies or Medicare. This practice is considered fraudulent, as it misrepresents the care that was delivered and violates healthcare compliance regulations. It is important to ensure that coding accurately reflects the services rendered, as upcoding can lead to severe penalties, including fines and loss of billing privileges. Proper coding is essential for maintaining the integrity of healthcare billing and compliance.