After reviewing notes about a new patient, a coder codes for a longer visit than occurred. Which term describes this action?

• A. Upcoding
• B. Fraud
• C. Misrepresentation
• D. Billing error

Answer: (B)

The action centers on intentional deception for financial gain in billing. Coding a longer visit than was actually provided is upcoding—the act of reporting a more extensive or costly service than delivered. Upcoding is considered fraud because it misleads the payer to obtain higher reimbursement than deserved. Therefore, the best term to describe the action is fraud, since it captures the illegal intent behind upcoding. The other terms relate to dishonest reporting or simple mistakes, but they don’t convey the same level of prohibited intent as fraud.