Asked by Iesha Martin on May 09, 2024
Verified
Assigning a diagnosis code that does not match patient documentation for the purpose or increasing reimbursement through the DRG system is known as:
A) downcoding
B) upcoding
C) unbundling
D) bundling
Diagnosis Code
Diagnosis Code refers to a code assigned to a diagnosis based on a standardized system, such as the International Classification of Diseases (ICD), used for healthcare billing and statistics.
Upcoding
Reporting a higher-level code than is appropriate for the service that was rendered, resulting in higher reimbursement; when a facility coder assigns a diagnosis code that does not match patient documentation, with the intention of increasing reimbursement to the facility through the DRG system, serious penalties and fines will be levied against the facility for submitting fraudulent claims.
DRG System
Diagnosis-Related Group (DRG) system is a way of categorizing hospital cases into groups for the purposes of payment, reflecting typical resource usage for a stay.
- Delve into the particulars and influence of the ICD-10-CM system versus other coding practices.
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Learning Objectives
- Delve into the particulars and influence of the ICD-10-CM system versus other coding practices.