Which practice involves billing for higher service or item codes than those actually performed?

• A. Fraud
• B. Kickback
• C. Unbundling
• D. Upcoding

Answer: (D)

Upcoding is billing for a higher-cost code than the service actually performed. In medical coding, each service has a code that reflects its complexity, time, and resources used. When a provider uses a more expensive code than what was delivered, the payer pays more than warranted. This intentional misrepresentation is a form of fraudulent billing and can lead to audits, repayment of funds, and penalties. For context, unbundling would involve billing separate components that should be covered by a single code, which is a different improper practice; kickbacks relate to improper payments for referrals, not the coding itself. So the described practice is upcoding.