Understanding Insurance Codes
Your medical bills and your Explanation of Benefits (EOB) will usually contain codes that stand for the services received and the benefits paid by your carrier. It's a good idea to know these codes so that you can easily verify that you have received the treatment listed on your bills and EOB.
Current Procedural Terminology (CPT) codes describe the services provided by your healthcare provider. The American Medical Association (AMA) developed these codes, and keeps them on file and charges a fee for coding books or online access. Your physician may have a list of the most common CPT and diagnosis codes, or you can search for the codes at the AMA Web site: https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp
Medicare employs a different set of codes, which supplement the CPT codes. They deal with services and goods that are not included in the CPT code list, such as wheelchairs, splints, prosthetics, ambulance service, and oxygen tents. These codes are called HCPCS (Healthcare Common Procedure Coding System), and information on them is available here: http://www.cms.gov/MedHCPCSGenInfo/
The World Health Organization (WHO) employs International Classification of Diseases (ICD) codes, which often serve as a check against the CPT codes. To search these codes, visit: http://apps.who.int/classifications/icd10/browse/2010/en
It's a good idea to check these codes against each other to ensure that your insurance carrier and your caregiver agree on what your condition is, what treatments you're receiving, and how reimbursement will be handled. A miscode can result in confusion at best, and non-payment of benefits at worst.
Analogous codes exist with regard to other types of insurance.
Current Procedural Terminology (CPT) codes describe the services provided by your healthcare provider. The American Medical Association (AMA) developed these codes, and keeps them on file and charges a fee for coding books or online access. Your physician may have a list of the most common CPT and diagnosis codes, or you can search for the codes at the AMA Web site: https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp
Medicare employs a different set of codes, which supplement the CPT codes. They deal with services and goods that are not included in the CPT code list, such as wheelchairs, splints, prosthetics, ambulance service, and oxygen tents. These codes are called HCPCS (Healthcare Common Procedure Coding System), and information on them is available here: http://www.cms.gov/MedHCPCSGenInfo/
The World Health Organization (WHO) employs International Classification of Diseases (ICD) codes, which often serve as a check against the CPT codes. To search these codes, visit: http://apps.who.int/classifications/icd10/browse/2010/en
It's a good idea to check these codes against each other to ensure that your insurance carrier and your caregiver agree on what your condition is, what treatments you're receiving, and how reimbursement will be handled. A miscode can result in confusion at best, and non-payment of benefits at worst.
Analogous codes exist with regard to other types of insurance.