Wiki physician coding-down coding?

can phyicians choose to down grade charges if they want?


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Hi. the orthopedic physician excised a bone lesion of the tibia and closed it with an allograft-27638. per coding guidelines you can only code for the allograft as the excision is inclusive. He wants to code for an excision w/ a biopsy to get higher RVUs-27635 and 20245 instead. Is this allowable? thanks
 
You cant pick and chose codes based on the reimbursement amount. CPT selection must accurately describe the services that took place. If he did a Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograft that is what he needs to report. Purposely miscoding in order to increase reimbursement would be a fraudulent billing practice.
 
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