Question

Assigning a diagnosis code that does not match patient documentation for the purpose or increasing reimbursement through the DRG system is known as:

Select one:
a. bundling
b. upcoding
c. downcoding
d. unbundling

Answer 1

Assigning a diagnosis code that does not match patient documentation for the purpose or increasing reimbursement through the DRG system is known as: b. upcoding

Step-by-step explanation:

b.Upcoding refers to the practice of assigning a diagnosis code that does not accurately reflect the patient's documentation, with the intention of increasing reimbursement through the Diagnosis-Related Group (DRG) system.

This unethical practice can result in financial gain for healthcare providers or facilities by making a patient's condition appear more severe than it actually is. Upcoding can distort healthcare statistics, compromise patient care, and lead to fraudulent billing practices.

Healthcare professionals are bound by ethical standards and are expected to code accurately based on the patient's actual medical condition. Upcoding undermines the integrity of the healthcare system, jeopardizes patient trust, and can have legal consequences.

Proper coding is essential not only for financial reimbursement but also for maintaining transparency, accuracy, and ethical standards in healthcare billing and documentation. Strict adherence to coding guidelines and ethical practices is crucial for the credibility and trustworthiness of the healthcare industry.