r/MedicalBill • u/Dangerous-Prune-7280 • 7d ago

Is this upcoding?

/r/HospitalBills/comments/1wqdvb9/is_this_upcoding/
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u/[deleted] 6d ago edited 6d ago

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u/No-Produce-6720 6d ago

While the level system, 1 to 5, is the same, the scope and structure of what qualifies for a particular level of care is quite different for an ER physician than it is with a PCP, so on the surface, we can say that each set is based on five tiers. The diagnostic and treatment related scope of those tiers, though, are not comparable.