If you have ever seen a medical claim form, summary of the visit, or explanation of benefits (EOB) statement and couldn’t understand what it meant because of all the numbers and letters, you may be wondering how you can find out what all the medical billing codes actually mean. Thankfully, there are online databases such as those at Find-A-Code.com that can be used to quickly search for a medical code to get the answers you want.
Medical coders and billers use different codes for different parts of a patient’s treatment. For example, they will use diagnosis codes called ICD (International Classification of Diseases) codes to describe a person’s disease, injury, or the symptoms associated with it. CPT (Current Procedural Terminology) codes are used to describe any of the treatments or services administered during the patient’s visit.
In most cases, individuals will not need to look up any medical codes. They will usually leave this to the healthcare provider’s team of coders and billers to take care of. In simple terms, the job of the coder is to translate all aspects of the patient’s file into the appropriate code and then pass this to the biller who will double-check it before creating an invoice to be sent to the relevant payer (insurance company or federal program). If everything is correct, the payer will reimburse the healthcare provider.
Why Would an Individual Need to Look Up Medical Codes?
Unfortunately, mistakes happen and not all insurance claim forms are paid promptly. In some instances, insurance claims are disputed or denied. It can also happen that patients will apply for pre-approval of a specific visit or treatment, but which is then denied. When faced with situations like these, many patients want to find out a bit more about their claim form and what information it contains.
If you have the ICD and CPT codes on hand along with the description of what they mean, it can make it easier for you to converse with those at the insurance company or federal program to find out more about what is happening with your case.
What Causes Insurance Claims to be Disputed or Denied?
If you know that the disease or injury you have and any treatments associated with it are covered under your insurance plan, it can be frustrating to discover that your claim has been disputed or denied. You might be wondering why this has happened.
There are a number of reasons why insurance claims forms are sent back, and it is usually to do with mistakes in the coding or missing information. Coders and billers are only human and, unfortunately, mistakes happen from time to time. Below are some of the more common reasons why insurance claims forms are disputed or denied:
- Incorrect information – either patient or provider. This could include name, address, DOB, insurance ID number, NPI (national provider identifier), etc.
- Incorrect policy information – policy number might be incorrect or have incorrect address information.
- Coding mistakes – incorrect ICD or CPT codes have been entered, bundled codes have been separated, codes for more expensive treatments than those carried out have been entered or vice versa, etc.
- Missing codes – the coder may have entered the ICD code and not the CPT code or vice versa.
It is not often that an individual would need to know what the various codes on their EOB statement or summary of visit mean, but when an insurance claim is disputed or denied, they might start to wonder what the problem is. Thankfully, with online databases, patients can find out more about the codes that are used by medical professionals and what they mean. They can then use this information when speaking with their insurance provider.