There are risks and downsides to up coding by deliberately billing lower level codes regardless of what services are performed.
For starters, it costs the practice money. One example is an audit of 10 charts with a total charge amount of $500. An audit showed that down coding accounted for a total loss of $125—25 percent of the total billed. In today’s atmosphere of low reimbursement, a 25 percent loss of revenue is unacceptable. The best strategy, proven effective by thousands of chart audits, is to clearly and thoroughly document the services provided and then bill in accordance with that documentation.