4 ms·

A few years ago, my wife hurt her back when we were moving. She went to the local urgent care center, and saw a doctor. We have insurance, and that was mostl

A few years ago, my wife hurt her back when we were moving. She went to the local urgent care center, and saw a doctor. We have insurance, and that was mostly the end of it for us. We later found out that the urgent care center had coded her visit as something like "surgical consultation" when it was nothing of the sort. I think the insurance company actually contacted my wife and inquired about the visit. We then got curious, and interested in the bill, and discovered that the codes are copyrighted. My wife actually was able to translate the codes using something she found in the local university library (which is how we realized that the visit was upcoded, and suddenly things made sense). We had thought that urgent care chain was just shady, but after reading this, I guess that this upcoding is a common practice.

coldcode 10y ago
Optimizing coding to maximize income is a major consultancy in the industry. The key is knowing what an Insurance company will accept without questions otherwise there will be a delay in getting your money or maybe you get nothing. Recently the coding system changed to a much more detailed version (which I think was in use internationally long before the US adopted it). I don't know if it's better but there are way more ways to code things today.
- awongh 10y ago
  I never realized all this existed! I'm still not clear from the article why the codes used inside the hospital are proprietary. copyrighted information- what kind of legal hoop jumping allows them to claim this? What kind of domain knowledge do you need to be able to code a procedure? Is it knowledge just of the insurance system, or is it also deeper medical knowledge / cultural knowledge of how doctors perceive / deal with one procedure over another?
  - coldcode 10y ago
    The codes are standardized but the interpretation by insurance companies isn't so clear. For the coding look at http://www.medicalbillingandcoding.org/qnas/what-are-the-different-types-of-medical-coding-classification-systems/ http://www.medicalbillingandcoding.org/qnas/what-are-the-dif...
friendzis 10y ago
I was under impression, that US uses variant of ICD-10 (ICD-9 few years ago) nationally, so WHO browser [1] should more or less work. Not sure if it is copyrighted per se, but most likely official document from CDC or something. It may be a way to milk more money from patients, but at a serious consequences: CDC has biased statistics, changing doctor could be problematic, and probably the doctor risks losing their licence due to document forgery charges. I thought that patients (both inpatients and outpatients) are required to give some form of confirmation (maybe verbal) on both correctness of anamnesis and understanding of discharge summary. One should probably always take copies with themselves to read those carefully. It would be nice if someone more knowledgeable on actual particulars could expand (I'm from metric land) [1]: http://apps.who.int/classifications/icd10/browse/2010/en#/Z00.0 http://apps.who.int/classifications/icd10/browse/2010/en#/Z0...

coldcode 10y ago

Optimizing coding to maximize income is a major consultancy in the industry. The key is knowing what an Insurance company will accept without questions otherwise there will be a delay in getting your money or maybe you get nothing. Recently the coding system changed to a much more detailed version (which I think was in use internationally long before the US adopted it). I don't know if it's better but there are way more ways to code things today.

awongh 10y ago
I never realized all this existed! I'm still not clear from the article why the codes used inside the hospital are proprietary. copyrighted information- what kind of legal hoop jumping allows them to claim this? What kind of domain knowledge do you need to be able to code a procedure? Is it knowledge just of the insurance system, or is it also deeper medical knowledge / cultural knowledge of how doctors perceive / deal with one procedure over another?
- coldcode 10y ago
  The codes are standardized but the interpretation by insurance companies isn't so clear. For the coding look at http://www.medicalbillingandcoding.org/qnas/what-are-the-different-types-of-medical-coding-classification-systems/ http://www.medicalbillingandcoding.org/qnas/what-are-the-dif...

friendzis 10y ago

I was under impression, that US uses variant of ICD-10 (ICD-9 few years ago) nationally, so WHO browser [1] should more or less work. Not sure if it is copyrighted per se, but most likely official document from CDC or something. It may be a way to milk more money from patients, but at a serious consequences: CDC has biased statistics, changing doctor could be problematic, and probably the doctor risks losing their licence due to document forgery charges. I thought that patients (both inpatients and outpatients) are required to give some form of confirmation (maybe verbal) on both correctness of anamnesis and understanding of discharge summary. One should probably always take copies with themselves to read those carefully. It would be nice if someone more knowledgeable on actual particulars could expand (I'm from metric land) [1]: http://apps.who.int/classifications/icd10/browse/2010/en#/Z00.0 http://apps.who.int/classifications/icd10/browse/2010/en#/Z0...