When you get medical bills, there are many numbers on the page.
But not all of them follow dollar signs.
Whenever a patient sees a doctor or has a procedure done, a medical code is assigned so that the proper payment can be made from the insurance company or patient to the doctor’s office for the service.
“(Insurance companies) can push that deny button so well if they find one little error,” said Sandy Watson, a recently retired medical coder who worked in the Wichita area for more than 25 years at various practices, from family medicine to orthopedics to anesthesiology. She also taught medical coding at Butler Community College for several years.
Watson encourages patients to pay attention to those codes since they can impact pocketbooks. She encourages people to ask for them from their insurance company once a claim has been filed if they don’t show up on the bill.
Over the years, she’s seen many cases where patients have been overcharged for services.
“Unless you have the codes, you aren’t going to know what the services are that they rendered,” she said.
Patients can look up the codes online at the American Medical Association’s website: https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do.
The website includes a description of the procedure, but does not include cost.
When providers document codes for procedures that are more severe than what the patient actually has, it’s called upcoding, which is illegal. The opposite, downcoding, also is illegal, Watson said.
Diagnosis codes can affect what services an insurance company will agree to pay for. For example, Medicare requires certain diagnosis codes for a condition before it will pay for procedures to help that condition.
Patients should start by looking at the office visit codes, Watson said.
“If they don’t do an exam, then they have to document time for counseling and coordination and care,” Watson said. “Each code has a time, a recommended base of time spent with the patient. 99213 is recommended as a 15 minute face-to-face visit. If you just see a nurse, it’s 99211. There are a lot of varieties in the way they can code something.”
She also says to check to make sure inpatient codes and outpatient codes haven’t been mixed up.
If a person suspects there is an error with their medical codes, Watson suggests calling the physician’s office first instead of the insurance company.
“Start from the source. Just ask them to please review it. Don’t attack them,” Watson said.
“A lot of people are angry because insurance didn’t pay, but anger doesn’t get you much. It just upsets the people you want to do extra work for you. Kill them with kindness. It won’t do any good the other way.”
If that doesn’t work, most payers give you about a year from the time the claim is filed to dispute the payment and get the physician’s office to refile, Watson said.