Medical Billing 101 - PDF

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					Medical Billing 101
                                                                                             By Vikki Sloviter

“It’s Greek to me.” How often          external causes and are used for       your child’s general assessment
have you taken your child to the       morbidity and mortality reports.       —it will be checked off on the en-
doctor and, at the end of the          Today, ICD-9-CM codes are a stan-      counter form and billed (CPT code
visit, handed the receptionist a       dard code that hospitals, doctors’     94760).
form that the doctor has partially     offices and insurance companies
filled out by checking off boxes or    use for medical billing.               Supplies, Vaccinations: Ad-
circling procedures or code num-                                              ditional categories include im-
bers? You may have no idea what        The Encounter Form                     munizations, injections, lab work,
you’re looking at, why that form       The printed form with the CPT          and supplies. Not only is the flu
is important, or what happens to       codes is often called an encounter     vaccine that your child received
that form after it leaves your hand.   form, and essentially describes,       last fall billed (90658) but the
But you should.                        in billing terms, what happened        administration of that vaccine is
                                       during your child’s office visit and   also billed (90471). And, if your
Generally understanding what the       what the office is going to bill the   child sprained her wrist and was
form—often called an “encounter”       insurance company. There are           given an arm sling, the sling is
form—is and what happens to it         usually two or three CPT code          billed (A4565).
after you leave the office is the      categories that the doctor checks
first step in understanding how        off: the type of office visit, the     Diagnosis: Usually on the bot-
health insurance works and un-         procedure(s) that were performed,      tom of the form with CPT codes
derstanding how your child’s office    and sometimes the supplies given       (or sometimes on the back),
visit coordinates with your health     or vaccinations that were admin-       you’ll either see a list of common
insurance. And why health insur-       istered.                               diagnosis codes with your child’s
ance costs so much.                                                           circled, or if there is no such list,
                                       Office Visit: One category is the      your child’s diagnosis code will be
Medical Coding                         type of office visit your child had    written down as a three-to-five
CPT codes: In 1966, the Ameri-         and how long it was. This category     digit number. Some common pe-
can Medical Association created        is often abbreviated “E/M” on the      diatric diagnoses include “eczema”
Current Procedural Terminology         form, for “evaluation and manage-      (692), “postnasal drip” (784.91),
(CPT), a national standard code for    ment.” The E/M code your child’s       “fussy infant” (780.91) and “bron-
medical services and procedures        doctor checks off corresponds to       chitis” (490)—not to be confused
that hospitals, doctors’ offices       the type of visit your child had.      with “acute bronchitis (466) or
and third-party billers (insurance     For example, if your child is an       “asthmatic bronchitis” (493.9).
companies) use.                        established patient (not new) and      If your child has any symptom or
                                       saw the doctor for about 10 min-       condition, there is an ICD-9 code
Today there are more than 8,000        utes, the CPT code 99212 would         for it.
codes to describe almost every         be checked off.
imaginable service and procedure                                              At this point you’re probably won-
that a patient may have performed      Procedures: A second category          dering why parents need to know
during an office visit, and every      includes the procedure(s) that         about medical billing. If you’ve
single one is billable. Every CPT      were 
				
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Description: In 1966, the American Medical Association created Current Procedural Terminology (CPT), a national standard code for medical services and procedures that hospitals, doctors' offices and third-party billers (insurance companies) use. First published in 1977 by the World Health Organization, these codes classify diseases by breaking them down into signs, symptoms, findings, complaints, circumstances and external causes and are used for morbidity and mortality reports.
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