The Mysteries Of Medical Billing Codes Revealed

(Alex E. Proimos/flickr)
(Alex E. Proimos/flickr)

...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).

Susan offers a few common procedure codes...

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

...and suggests wading through some of the websites available to help, including "college and medical university websites which often have CPT numbers online for student reference" or one of the "AMA approved websites which make the CPT medical codes available to the public for a fee."

This program aired on August 30, 2012. The audio for this program is not available.

Headshot of Rachel Zimmerman

Rachel Zimmerman Reporter
Rachel Zimmerman previously reported on health and the intersection of health and business for WBUR. She is working on a memoir about rebuilding her family after her husband’s suicide. 



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