Typically, you will see these codes on your Explanation of Benefits and medical bills.
It’s important to understand these codes so you confirm that no mistakes were made in the billing process.
This can potentially save you money, depending on your health coverage.
DNY59 / E+ / Getty Images
Your EOB is a window into your medical billing history.
For example, millions of Americans have jot down 2 diabetes along with high blood pressure and high cholesterol.
Coding Systems
Health plans, medical billing companies, and healthcare providers use three different coding systems.
CPT codes are developed and updated by the American Medical Association (AMA).
The AMA issues an annual update to the CPT codes.
However, the AMA does not provide open access to the CPT codes.
Medical billers who use the codes must purchase coding books or online access to the codes from the AMA.
Your healthcare provider’s office may share this form with you.
Level I HCPCS codes are the same as the CPT codes from the American Medical Association.
Medicare also maintains a set of codes known as HCPCS Level II.
), prosthetics, orthotics, and supplies that are used outside your healthcare provider’s office.
However, a chest X-ray is appropriate and would be reimbursed.
In addition, your health plan may deny your claim and not pay anything.
Even simple typographical errors can have significant consequences.
Examples of Coding Errors
Doug M. fell while jogging.
Because of pain in his ankle, he went to his local emergency room.
Several weeks later Doug got a bill from the hospital for more than $500 for the ankle X-ray.
When his EOB arrived, he noticed that his health plan had denied the X-ray claim.
Doug called his health plan.
It took a while to correct an error made by the billing clerk in the emergency room.
(Remember that “covered” doesn’t necessarily mean “paid for.”
Doug would still have to pay any applicable deductible, copay, or coinsurance).
In that case, the patient will have to pay their deductible, copays, and/or coinsurance.)
Summary
For every medical procedure, there’s an associated code.
The CPT (Current Procedural Terminology) codes are developed and maintained by the American Medical Association.
And ICD-11 (International Classification of Diseases, 11th revision) is maintained by the World Health Organization.
There are several steps in the process of filling out and submitting a medical claim.
Along the way, the humans and computers involved in the process can make mistakes.
Medicare.gov.Medicare Summary Notice (MSN).
American Medical Association.CPT Purpose and Mission.
American Medical Association.AMA releases CPT 2024 code set.
American Medical Association.CPT code set keeps pace with health care technology, innovation.
Oct. 8, 2024.
American Medical Association.Need coding resources?
AAPC.99202-99215: Office/Outpatient E/M Coding in 2021.
Find-A-Code.CPT 93000 in section: Electrocardiogram, routine ECG with at least 12 leads.
Medical Economics.How to Properly Document and Bill for Venipuncture.
Fast Pay Health.Are Your Prepared for 2022 CPT Code Changes?
Centers for Medicare and Medicaid Services.HCPCS Level I & II Contacts.
Centers for Medicare & Medicaid Services.Healthcare Common Procedure Coding System (HCPCS).
Accessed Nov. 17, 2024.
Centers for Medicare and Medicaid Services.HCPCS quarterly update.
World Health Organization.WHO Releases New International Classification of Diseases (ICD 11).
Independence Blue Cross Blue Shield.Transition to ICD-10: Frequently Asked Questions.
ICD-11 for Mortality and Morbidity Statistics (Version: 02/2022).4A44.A1 Granulomatosis with polyangiitis.
ICD-11 for Mortality and Morbidity Statistics (Version: 02/2022).ND14.7 Strain or sprain of ankle.
Hirsch JA, Nicola G, Mcginty G, et al.ICD-10: History and context.AJNR Am J Neuroradiol.
Accessed Nov. 17, 2024.
HealthInsurance.org.Why do some mammograms and colonoscopies have cost-sharing?
WebPT.8 Things you better Know Now About ICD-10.
ICD10data.com.The Web’s Free ICD-10-CM/PCS Medical Coding Reference.
