Medicare Billing Codes - how can you upcode?

Is there something in the Medicare manual that says something along the lines, "Providers must use the most specific code that matches the services provided. The provider must document the specific elements required to satisfy the criteria for the code used to describe services provided. If a procedure is performed and less than all of the required elements are met, the provider cannot charge for the higher code and must use a lesser code."

Thanks so much for your help! Bonus points if you can post a link to website.

Yes. Upcoding without necessary/significant documentation constitutes Medicare fraud and you will go to jail for it.

http://www.medicare.gov/FraudAbuse/Overv...

Fred is right - upcoding is illegal and you could face serious concequences when committing Medicare fraud.
When billing CPT codes, you must use the code that best describes the procedure performed.
Example: If the doctor spends 15 minutes with the patient in an office visit, you'd have to code is as 99212. If you billed a higher code like 99215, you'd better have complete documentation to prove that at least an hour was spent with the patient.
Do not upcode - it's illegal and completely unethical.

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