Upcoding is the practice of using a code on a claim form that indicates a higher level of service than that which was actually provided. This can lead to an increase in payment from the insurance company, which is why it is considered fraudulent.

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What Is Upcoding

Question 28

Multiple Choice

What is upcoding?

A) Coding by the insurance company's rules of what it will pay
B) Codes that corroborate the documentation in the medical record
C) A code on a claim form that indicates a higher level of service than that which was actually performed
D) Codes that are identified as those that are not permitted

Correct Answer: