What is the definition of "downcoding"?

The definition of "downcoding" refers to the practice of assigning a code that reflects a lower level of service or complexity than what the documentation supports, resulting in a lower reimbursement than what is justified. This typically occurs when a healthcare provider submits a claim for a service but the coding is done in such a way that it reflects less intensive care than what was actually provided.

In the context of healthcare, accurate coding is crucial for appropriate reimbursement. When coding is downcoded, it not only affects the revenue for the provider but may also indicate the potential for the services rendered to be underestimated. This practice can arise from various factors such as misunderstanding coding guidelines, unintentional mistakes, or even an attempt to avoid audits or penalties by coding conservatively.

In contrast, the other choices do not accurately capture the essence of downcoding. Assigning codes that yield higher reimbursements or providing additional documentation to support a higher code would not reflect downcoding but rather an attempt to maximize revenue, while reclassifying a service to a less complex category can relate to various coding scenarios but does not necessarily imply reimbursement is lower than justified.