Question

A physician instructed his outpatient coder to report multiple codes in order to try and increase reimbursement when a single combination code should normally be reported. What is this called?

A) overcoding
B) upcoding
C) unbundling
D) jamming

Answer 1

Overcoding is the term used when a physician instructs a coder to report multiple codes instead of using a single combination code in order to increase reimbursement.

Step-by-step explanation:

The correct answer is A) overcoding. Overcoding occurs when a physician instructs a coder to report multiple codes instead of using a single combination code in order to increase reimbursement. By reporting multiple codes, the physician hopes to maximize the amount of reimbursement received for the services provided. Overcoding occurs when reporting Current Procedural Terminology and Healthcare Common Procedure Coding System codes results in a higher payment than warranted for services provided. Upcoding also occurs when a service performed is not covered by Medicare, but the provider bills a covered service in its place.