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What is Medical Upcoding?


Medical Upcoding - A coding inconsistency that involves using a code for a procedure or diagnosis that is more complex than the actual procedure or diagnosis and that results in higher reimbursement to the provider.



Medical Upcoding is a relatively new term for an action that has been taking place for a number of years. This is when a medical provider purposely uses a code of higher costs than necessary for procedure being provided. This process cannot be fully understood until there is a clear understanding of CPT (current procedure technology) codes. These codes define what services are provided during a medical procedure or diagnosis. These codes play a tremendous factor in the amount that a patient is charged.


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For more information on the CPT codes, please refer to the following sites:
http://en.wikipedia.org/wiki/Current_Procedural_Terminology












Citations/References
http://quitam-lawyer.com/upcoding-unbundling-fraud.html

http://www.pohly.com/terms_u.html