Which statement best describes Upcoding?

Which statement best describes Upcoding?

• A. Billing for a cheaper service than performed
• B. Billing for a more expensive service than performed
• C. Billing for a same service as performed
• D. Billing for multiple services not provided

Answer: (B)

Upcoding is when you bill for a higher-cost service than what was actually performed. In practice, you select a more expensive CPT code than the care the patient received, which inflates reimbursement and constitutes fraud. For example, billing a comprehensive, higher-paying service code when only a basic adjustment was done misrepresents the care provided and can lead to legal and professional consequences. Other scenarios described by the other options—billing for a cheaper service, billing the same service as performed, or billing for multiple services not provided—do not match up with upcoding. The first would be underbilling, the second would reflect accurate billing, and the last describes unbundling or billing for services not rendered.

Upcoding is when you bill for a higher-cost service than what was actually performed. In practice, you select a more expensive CPT code than the care the patient received, which inflates reimbursement and constitutes fraud. For example, billing a comprehensive, higher-paying service code when only a basic adjustment was done misrepresents the care provided and can lead to legal and professional consequences.

Other scenarios described by the other options—billing for a cheaper service, billing the same service as performed, or billing for multiple services not provided—do not match up with upcoding. The first would be underbilling, the second would reflect accurate billing, and the last describes unbundling or billing for services not rendered.