Downcoding: The Revenue Risk Healthcare Organizations Can’t Ignore
When healthcare organizations think about coding risks, overcoding often gets the most attention. However, downcoding can be just as problematic. Downcoding occurs when a service is reported at a lower level than supported by the documentation or when a payer reduces a submitted claim to a lower-paying code, resulting in reduced reimbursement. While this may seem less risky than overcoding, inaccurate coding in either direction can create compliance concerns and negatively impact revenue (AAPC, n.d.). …
