Downcoding in Medical Billing
Downcoding is the practice of using a lower-level procedure or diagnosis code than what was actually performed, often leading to reduced reimbursement.
Downcoding in Medical Billing Explained
In medical billing, downcoding may occur either intentionally or by mistake. It can lead to financial losses for the provider because the lower-level code results in reduced reimbursement. Insurance companies may downcode claims if they believe the service was over-coded or not medically necessary.
For example, a physician’s office may accidentally downcode a complex procedure as a routine service, resulting in lower payment from the insurance company.
Learn more about common acronyms and abbreviations in Medical billing glossary.
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