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Upcoding
Reporting a higher-level code than is appropriate for the service that was rendered, resulting in higher reimbursement; when a facility coder assigns a diagnosis code that does not match patient documentation, with the intention of increasing reimbursement to the facility through the DRG system, serious penalties and fines will be levied against the facility for submitting fraudulent claims.
DRG System
Diagnosis-Related Group (DRG) system is a way of categorizing hospital cases into groups for the purposes of payment, reflecting typical resource usage for a stay.
External Causes Of Injuries
Factors outside the body that can cause physical harm, such as accidents, violence, or environmental exposure.
ICD-9-CM Manual
A medical classification list by the World Health Organization for diseases, symptoms, and procedures, used primarily before October 2015 in the United States.
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