July 17, 2007

Secrets of Medical Billing

Did you ever wonder what those codes mean on your medical bill? How do you know you were billed for the right procedure?

Last month I went to the Doctor’s office to finally get my test results from April (turns out I am in perfect health). While at the Doctor’s office I decided to get a tetanus shot, since I hadn’t had one since probably 1995. The nurse gave me the tetanus shot with some other “stuff” in it. I figured it was the diphtheria and pertussis shots, but she didn’t clarify it.

A few weeks later, I get the insurance statement saying the shot I got was not covered under my policy. A few weeks before my wife got a tetanus shot and it was covered. After spending quite a while on the phone with the spokesperson at the insurance company, she said the billed code is not covered, however, if the Doctor’s office rebilled the shot under another code, then maybe it would be covered. What? I called the Doctor’s office and they said they would rebill the shot under a different code.

A few more weeks later, I get the rebilled insurance statement stating that everything was covered with the different code.

What do these codes mean? I decided to find out. A couple of web sites were helpful in determining what the codes mean. The first site is from Perdue University.
The second site comes from the AMA.

Check back tomorrow for further analysis of the billing codes.

The codes are usually listed right below the description on your bill. Grab your most recent statement and find what you have been charged for.
Here are some sample codes:

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