Wiki Billing Office Visit INSTEAD OF Procedure

[Brenda88]

I was once told by another coder that if a provider does a procedure that we know is not covered by insurance, we can bill an office visit for that diagnosis instead.

I've been unable to confirm whether that's true. When I search online, everything is about billing the office visit in addition to the procedure, not instead of. Is it ok to take the procedure off and put an office visit in its place?

 

[csperoni]

So, the other coder suggested intentionally using an incorrect code for the purposes of receiving payment for a service that is not covered. My answer is "NO!!!!!!!"

https://www.cms.gov/files/document/overviewfwacommonfraudtypesfactsheet072616pdf