Upcoding is the assignment of a DRG that does not match documentation and is for the purpose of increasing outpatient reimbursement.

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Upcoding refers to the practice of using billing codes that reflect a more severe or expensive diagnosis or treatment than what was actually provided or documented, not specifically to DRG assignment or limited to outpatient reimbursement. It can occur in both inpatient and outpatient settings.

Upcoding Is the Assignment of a DRG That Does Not