Not coding vs. undercoding


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There is a debate in our office and we need some clarification.

We are all in agreement that under-coding is just as much considered to be fraudulent as over-coding. However, what if the provider wants to not bill for a procedure that he clearly dictates and is billable, is that fraudulent?

Any input would be greatly appreciated.


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Sorry but, Yes it can be considered fraud. I just learned this myself. In the event of a lawsuit you would be liable for witholding information. Your medical records will not match the bill you sent. In the event of a lawsuit it would indicate you were hiding something. If for any reason the carrier ask for a copy of the opertative and you did not fully disclose the medical condition and treatment of the patient you may be looking at refunding. One of our nurses did some consulting for a law firm for a while, this is exactly what she was hired to look for.

You might decide to have the doctor dictate seperate opertative reports for the same date of service. Some procedures might be paid in cash and there is no reason to bill the carrier for it. So your medical records would reflect both procedures but would also reflect the REASON you did not bill the carrier.
hope this helps.