Figuring Out Your Medical Coding – What Doctors Are Hiding From You

August 30, 2012 in Hospital Bills, Insurance Bills

The curiosity bug bites us all from now and then, but especially so when something has to do with our own health. Imagine the frustration of having a piece of paper in front of you that tells you everything that’s wrong with you, what the doctors plan to do about it, and how much it’s going to cost you. Well, with medical coding, this frustration becomes a reality. Right there on your bill or summary or any other document given to you by your health care provider is the medical codes that hold the answers to all of the questions you have.

But medical coding is a locked answer booklet, oftentimes only decipherable by health care professionals and those within the medical coding profession. That’s because the American Medical Association (AMA) keeps a tight lid on what these codes mean, mostly so that they can keep their billing practices under wraps, but also to make money. But what can you do about this as a patient? Well, as it turns out, quite a bit. Let’s find out how you can figure out what your medical coding means.

What Is The Most Common Medical Coding?

Chances are the medical coding you’re seeing on your documentation is the Current Procedural Terminology, or the CPT for short. These medical coding numbers are assigned to each and every task, service, treatment or health care plan that a doctor provides for their patient (with the exception of those covered by Medicare). This includes:

  • Medical diagnosis
  • Surgical procedures
  • Diagnostic services
  • And just about everything else a doctor provides

The CPT medical coding numbers are then sent off to the insurance agencies so that the amount of reimbursement the doctor will receive under your insurance can be calculated. The medical coding numbers are meant to ensure uniformity across the boards, but some suspect they are simply meant to hide your options from you until a doctor knows how much money they will receive for certain services from your insurance company. This allows them to assess which will make them the most guaranteed money (from insurance companies) and what their cost/risk will be (payment out of the patient’s pockets).

Who Makes CPT Codes?

As mentioned above, CPT medical coding is not only developed and overseen by the AMA, but also copyrighted. Because codes are constantly getting out to the public, the AMA is constantly revising existing codes, devising new medical coding for new procedures and discarding medical coding for outdated procedures no longer used. This means that at any given time, there are hundreds of thousands of medical codes in use which are updated annually.

By keeping these codes close to the vest, the AMA is able to make millions of dollars each year by selling software, books and manuals to medical coders, insurance companies and practitioners who need this information.

What Does Medical Coding Look Like?

Here are a few examples of common CPT medical coding:

  • 99214 indicates a physical was given
  • 90658 indicates a flu shot was given
  • 90716 indicates chicken pox vaccine was given
  • 12002 indicates a one-inch cut on a patient’s arm was stitched up

As you can see, the medical coding can get very specific so don’t be surprised when you see numerous CPT numbers on your charts.

Finding Out What CPT Medical Codes Mean

If you’re looking to find out more about your medical coding to protect your rights as a patient, the first thing that you want to do is visit online medical sources, especially college and medical university websites which often have CPT numbers online for student reference. While difficult to find because of the AMA fining people for publishing free CPT medical coding references online over the years due to copyright infringement, if you dig deep enough into the web, chances are you’ll find what you need.

Another option is to sign up for AMA approved websites which make the CPT medical codes available to the public for a fee. While not the best option, you certainly will find out what your medical coding means.

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