US Medical Term · insurance
Upcoding
Sobrecodificación
In 9 languages
| Language | Term |
|---|---|
| English | Upcoding |
| Spanish (Español) | Sobrecodificación |
| Chinese (中文) | 過度編碼 |
| Korean (한국어) | 상향 코딩 |
| Vietnamese (Tiếng Việt) | Nâng mã hóa |
| Filipino (Tagalog) | Upcoding |
| Portuguese (Português) | Upcode |
| Thai (ภาษาไทย) | การเพิ่มระดับรหัส |
| Japanese (日本語) | アップコーディング |
What it means
Upcoding is fraudulent or abusive billing practice in which a healthcare provider submits a billing code for a more complex, higher-cost service than was actually performed. For example, billing an extended office visit code for what was a brief routine check-up. Upcoding increases the provider's reimbursement and may also increase your cost-sharing if you pay a percentage of the charge. It is illegal under federal fraud and abuse laws and can result in large fines or exclusion from Medicare and Medicaid. Patients can spot upcoding by carefully reviewing their EOB and asking for an itemized bill if the charges seem unusually high.
How to say it
Sentences a patient might use with a doctor, nurse, pharmacist, or insurer:
My EOB shows a code for a longer visit than I had — could this be upcoding?
Mi Explicación de Beneficios muestra un código para una visita más larga de la que tuve — ¿podría ser sobrecodificación?
How do I report suspected upcoding to my insurance or to a federal agency?
¿Cómo reporto una posible sobrecodificación a mi seguro o a una agencia federal?
Can you send me an itemized bill so I can verify the codes match the services I received?
¿Puede enviarme una factura detallada para que pueda verificar que los códigos coincidan con los servicios que recibí?
Where you'll see it
Related terms
Sources
Last reviewed: September 2026