If a payer judges that a code level assigned by a practice is too high for a reported service, the usual action is to
A) upcode the reported procedure code.
B) add a modifier to the reported procedure code.
C) deny the claim.
D) downcode the reported procedure code.

Question

Quizplus · Accepted Answer

When a payer believes the code level assigned by a practice is too high for the service reported, they typically downcode the reported procedure code to reflect what they consider to be the appropriate level for the service provided. This action adjusts the billing to what the payer deems accurate, rather than denying the claim outright or requiring modifications to the code.

If a Payer Judges That a Code Level Assigned by a Practice