Undercoding vs Overcoding

Undercoding occurs when the code billed does not adequately represent the full extent of medical decision making performed by the physician and can equate to lost revenue. Undercoding means potential revenue is left on the table because you didn’t accurately code the procedure performed and missed out on reimbursement.

Overcoding of CPT codes is the reporting of a higher code than what accurately represents the work done by the physician. Overcoding has a higher potential compliance risk, because payers will reimburse you at a higher level than what you should get. It can result in accusations of fraud, along with stiff legal penalties.

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