Understanding Medical Billing
- 1). Review the ICD9 and CPT codes. This can be done online or via printed manuals available at most bookstores. ICD9 codes should be considered diagnosis codes, the reason that the person came to see a health care professional. CPT codes are what the doctor or health care provider did. Regardless of the type of medical provider, the code for an office visit remains basically the same, but other codes may be influenced by the type of provider or the facility where the service is completed; for instance, hospitals bill differently than doctor's offices.
- 2). Learn the most basic codes and their restrictions. While an office visit may seen like an office visit, the CPT codes differentiate between a brief visit and an extended one.
- 3). Read the CPT code descriptions and the coordinating ICD9 code. An interesting part of medical billing is that most insurance companies will reject a claim if the diagnosis code (ICD9) does not match the procedure code (CPT). That means if your doctor tries to bill you for oral surgery, but you went in for a bruised toe, the insurance company will probably deny the claim.
- 4). Concentrate on the sections of the ICD9 and CPT codes that are relevant to the doctor or health care provider you are seeing or they type of diagnosis that you have. Both codes lists are divided into sub-sections that make it relatively easy to concentrate on a specific area, so if you are learning medical billing for dentistry, you really don't need to learn the codes for optometry.
- 5). Talk to your doctor or health care provider about the codes they use. Sometimes the description of a procedure can be vague or seem just like the description of the code next to it. Ask your doctor's office why it chooses one code over another.
