Medical Advocates Check for Use of Proper Codes

With those documents in hand, a medical advocate reviews and questions all of the hospital’s charges, meticulously going over many pages of charges, line by line. They check the ICD codes, which describe the medical diagnosis for a condition (International Statistical Classification of Diseases and Related Health Problems). ICD codes for various conditions can be found on the web.

More importantly, medical advocates check all CPT codes (Current Procedural Terminology codes for procedures and services). It is not unusual for hospital bills to list charges for treatments and services not received by the patient and/or not appropriate for the patient’s diagnosed condition.

CPT codes were created and are maintained by the American Medical Association, which has copyrighted its CPT coding system. Most service providers who use the CPT codes pay license fees to the AMA for being able to use them. This is where medical advocates’ experience in dealing with medical codes comes in handy, as individuals can’t just look up CPT codes on the internet (although Wikipedia has a general description of what they are and how the codes are structured into categories).

All HCPCS codes (Healthcare Common Procedure Coding System codes for those health related products, supplies and services not covered in the CPT codes) are checked as well. These codes are accessible to the public, because they maintained by the government through the Centers for Medicare and Medicaid Services. However, be forewarned that searching through HCPCS codes is time-consuming and incredibly frustrating for the uninitiated. This is where experienced medical advocates are simply better at wading through the voluminous tables and other materials available on the web.

Once the client’s notes, detailed hospital bills and appropriate codes are all on hand, then the actual review of the bills can begin. Remember that about 80% of medical bills contain errors, and one can be certain that those are not errors which result in the patient paying less than what is due. Not surprisingly, the errors found in medical bills almost universally result in overcharging, with insurance companies and individuals dramatically overpaying for what services and treatment were actually rendered.

Our office is expert at helping find insurance to pay these bills, or at negotiating a reduction in proper cases where there is inadequate insurance.

Please call us today at 916.921.6400, or use our online contact form for a free consultation.

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