Definition of upcode in English:


Pronunciation /ˌəpˈkōd/ /ˌəpˈkoʊd/

transitive verb

[with object]
  • Assign an inaccurate billing code to (a medical procedure or treatment) to increase reimbursement.

    ‘if you are asked to upcode drug charges to increase reimbursement, will you refuse to do so or go along with the flow?’
    • ‘auditors discovered that they had been upcoding for years’
    • ‘They have gotten a directive from on high at the Dept. of Health and Human Services that the so called error rate for billings needs to fall below 4%. The Dept. of Health and Human Services defines upcoding as a billing error.’
    • ‘Another reason for upcoding your patients' illnesses is to manipulate reimbursement rules for your patients' benefit.’
    • ‘If financial gain is the only justification for upcoding or downcoding, then it is deceitful.’
    • ‘It may also be a good indication that the physician is upcoding or downcoding, both of which can be costly.’
    • ‘When a physician upcodes or downcodes an evaluation and management claim, most of the time it's only by one level.’
    • ‘We also find that hospitals replacing their management subsequently upcode more than a sample of similar hospitals that did not.’
    • ‘For example, a simple five minute procedure would be routinely upcoded and billed for a more complicated and longer higher reimbursement procedure.’
    • ‘In January, the hospital agreed to pay $2 million to settle allegations that it upcoded diagnosis codes to increase reimbursement.’
    • ‘Groups should be aware that if they have one physician who consistently upcodes, the group and the individual physician may be liable for that conduct.’