Undercoding

Is your practice constantly faced with the problem of under-coding?

Under-coding is defined as the process of medical coding wherein the codes used are not reflective of the full extent of treatment that the patient received. It is often the result of failing to abstract every code from the medical record or to select the highest specificity of codes. Like overcoding, it can lead to rejected or denied claims, not to mention decreased revenue. But under-coding can also lead to other, more serious problems, which is why it is crucial to avoid this mistake.

The Problem with Under-Coding

Despite resulting in lower revenues for practices, under-coding is still considered fraudulent and can lead to investigations or audits. Some coders think that under-coding is “playing it safe” when you’re unsure, but really it isn’t. It can be seen as inducement, or the practice of offering a free service to patients in order to encourage them to avail of a service that is covered by the insurance provider. This can lead to legal action on the grounds of fraud and abuse.