Upcoding

What does Upcoding mean on a medical bill?

Upcoding is billing a code that pays more than the care actually delivered supports — a brief visit billed at the highest level, a simple procedure billed as a complex one, a nurse's work billed as a physician's. From outside it is hard to prove, because the same code can be right or wrong depending on what the chart says. What you can do is compare the level billed against what you remember and against the records, and ask the billing office to review anything that does not line up.

What should I watch out for with Upcoding?

• A visit level that does not match how long you were there or what was actually done
• Ask for the records supporting the level billed, then read them against your own memory of the visit
• The same complaint billed at a higher level than an identical earlier visit — ask the biller to review