downcode

downcode

(down′kōd″)
To assign a lower billing code than usual to a patient visit.
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fEM = Fraction of cases identified in the EM-DRG audits to total number of cases reviewed Audit data is available for all cases, based on billing data and evaluation/management codes with downcode and upcode historical data validated by recoupment amounts R = Readmission rate of total hospital or DRG Readmission rates are available from CMS for Medicare inpatients and hospital administration dashboards for commercial insurers.
SHOOT: Liverpool North's Aiden O'Brey gets a shot away as Maghull defender James Morris tries to close him downCode zz090513 JuniorCG10
199), giving an acute problem a more severe diagnosis than presenting symptoms warrant for a presenting problem, or to "downcode" (p.
The solution is designed to help reduce improper upcoding and alleviate the need for hospital coding staff to downcode procedures due to inadequate documentation.
An increase in the number of indicators would reduce the focus on particular diagnoses and diffuse pressure to downcode administrative data for safety reporting purposes.
And the insurers will no longer automatically downcode evaluation and management codes, and will separately identify and pay modifier -25, which allows physicians to bill for evaluation and management service on the same day as a procedure.
In several cases, physicians allege that insurers "downcode" or "bundle" codes for services, thereby paying less for a more expensive service or combining services and paying the cheaper bill.
At the same time, studies suggest that half of primary care physicians would "downcode," or use physical symptoms for major depressive disorder if the patient was concerned about labeling or confidentiality, said Dr.
And both will no longer automatically downcode evaluation and management codes, and will separately identify and pay modifier-25, which lets physicians bill for evaluation and management service on the same day as a procedure.
So how can it make the determination to downcode? It can't."
Instead of taking time to pull out a coding reference, physicians may intentionally downcode to ensure that their documentation supports their code, or they may erroneously apply a higher service code not supported by the details they have documented.
The complexity of medical decision making is classified as straightforward or low, moderate, or high complexity, depending upon the number of diagnoses, amount of data reviewed, and the level of involved risk, Instead of taking time to pull out a coding reference, physicians may intentionally downcode to ensure that their documentation supports their code, or they may erroneously apply a higher service code not supported by the details they have documented.