Can chiropractors undercode on a claim?

• A. Yes, sometimes
• B. No, never undercode
• C. Only with payer approval
• D. Always undercode to save time

Answer: (B)

Accurate coding means billing for exactly what was provided and documented. Undercoding—billing a lower-level code than the service actually performed or that is supported by the chart—is a misrepresentation of care. Payers expect codes to match the intensity, complexity, and time of the visit, and choosing a lower code to save time or avoid attention can be treated as submitting a false claim, with potential legal and financial consequences.

The best practice is to code to the level that the documentation supports. If the chart shows a broader, more complex service, you should bill for that higher level and ensure the documentation justifies it. If you can’t justify a higher code because the documentation doesn’t support it, you should not bill it at all and may need to improve or add to the documentation so it accurately reflects the care provided. Intentional downcoding to avoid scrutiny or reduce payment is not permissible and can trigger audits, recoupments, fines, or other penalties.

In short, do not deliberately undercode. Maintain truthful, well-supported documentation and code for the service actually provided, using the code that best reflects the care delivered.