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downcode, v.

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Origin: Formed within English, by derivation. Etymons: down- prefix, code v.

  transitive and intransitive. To designate (a performed medical procedure or related insurance claim) with a lower cost value.

1988   [implied in: Med. Econ. 18 July 75/1   Downcoding was another common reason for appeal. We'd bill for one service, and Medicare would automatically change it to a lower code. (at downcoding n. at Derivatives)].
1989   Wall St. Jrnl. 29 Dec. 1   Medicare claims are being denied, delayed and ‘downcoded,’ or reimbursed at lower rates than doctors expect.
1991   Xenia (Ohio) Daily Gaz. 24 Oct. 6/3   Insurance companies also downcode when a new technology is not yet in the insurer's computer data base.
2000   Dermatology Times 21 14   The House of Delegates has passed resolutions..to support legislation requiring payers to notify physicians when they downcode.
2016   Med. Econ. 25 Jan. 54   Certain words or phrases will make payers downcode or deny claims.

1988—2016(Hide quotations)

 

Derivatives

 
 

  ˈdownˌcoding   n.

1988   Med. Econ. 18 July 75/1   Downcoding was another common reason for appeal. We'd bill for one service, and Medicare would automatically change it to a lower code.
2004   Chicago Tribune (Midwest ed.) 7 Mar. i. 17/1   In one common maneuver known as ‘downcoding’,..the insurance companies automatically changed billing codes to reflect lower-priced services than those actually provided.
2016   J. Jurek et al. Conquer Med. Coding xiv. 494   Downcoding is an attempt to play it safe and avoid carrier scrutiny.

1988—2016(Hide quotations)

 

This is a new entry (OED Third Edition, December 2018).

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