Which coding practice involves reporting a higher-level service than was actually performed?

The practice of reporting a higher-level service than what was actually performed is referred to as upcoding. This term specifically describes a situation where codes used in billing suggest a more complex or intensive service than was provided, often to increase reimbursement amounts from payers. Upcoding can result in significant legal and financial consequences, as it misrepresents the services rendered, potentially leading to allegations of fraud.

While similar terms exist, they refer to different aspects of coding. For instance, the term overcoding might also imply incorrect reporting, but it does not specifically carry the same connotation or definition as upcoding in the context of service level representation. Understanding the terminology around coding practices is essential to maintain compliance and ensure accurate billing practices in healthcare.