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from the are-the-codes-secret-are-they-safe? dept.
Elisabeth Rosenthal writes in the NYT that she has spent the past six months trying to figure out a medical bill for $225 that includes "Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others" and she really doesn't want to pay it until she understands what it’s for. "At first, I left messages on the lab’s billing office voice mail asking for an explanation. A few months ago, when someone finally called back, she said she could not tell me what the codes were for because that would violate patient privacy. After I pointed out that I was the patient in question, she said, politely: “I’m sorry, this is what I’m told, and I don’t want to lose my job.”" Bills variously use CPT, HCPCS or ICD-9 codes. Some have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to comprehend. Some have no information at all. Heather Pearce of Seattle told me how she’d recently received a $45,000 hospital bill with the explanation “miscellaneous.”
So what's the problem? “Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that,” says Mark Hall. “We’ve not seen a lot of pressure to standardize medical billing, but there’s certainly a need.” Hospitals and medical clinics say that detailed bills are simply too complicated for patients and that they provide the information required by insurers but with rising copays and deductibles, patients are shouldering an increasing burden. One recent study found that up to 90 percent of hospital bills contain errors and an audit by Equifax found that hospital bills that totaled more than $10,000 contained an average error of $1,300. “There are no industry standards with regards to what information a patient should receive regarding their bill,” says Cyndee Weston, executive director of the American Medical Billing Association. “The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input. That would certainly be a worthwhile project for our industry.”
(Score: 2, Informative) by Anonymous Coward on Tuesday May 05 2015, @06:47PM
And as a physician I'd expect you have the resources to hire a good lawyer when you're threatened with being sent to a collection agency, and also the ability to comprehend the language of the patient notes.
Most people don't, for either of the above. And so what do you advise the minimum-wageish earner to do when the practice says, "Pay up or be sent to a collection agency...."
I've never caught a billing mistake, even though I can parse ICD-9 and CPT. I've seen systematic upcharging on some of my E&M charges, but you can't fight that. (10 minutes of physician time for a routine item translating to a level 4 visit, for example.)
That said, for the article's submitter, for Elisabeth Rosenthal and from https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx [cms.gov] :
87481 Candida dna amp probe
87491 Chylmd trach dna amp probe
87798 Detect agent nos dna amp
No, I'm not making those up, and they may have been routine screenings rather than diagnostic.... Hope so, anyway. But anyway, that CMS site will let you plug in the five-digit CPT codes and get a description of what the code is along with the Medicare allowable amount for any Medicare jurisdiction and/or the national payment amount for Medicare. Even Googling "CPT 87481" will give you enough information on the search results page.... though going beyond and clicking any links requires good knowing what you're doing against a virus trap.
As to the other, three digit codes, those are almost certainly lab index numbers from whatever laboratory performed the tests - that would take talking to whomever did the actual testing.
Final piece of advice: Do NOT argue with the first line/front line billing or reception people. They almost certainly have not been given authorization to discuss the matter to you. Speak to a billing supervisor and/or clinical staff to get them to translate the codes, and to communicate with you about your treatment and the codes used. There will be people to talk to you, but thanks to HIPAA/ARRA/HITECH and $50,000 fines for noncompliance you can be damn sure nobody who isn't authorized to give you the information should be talking to you about it.
(Score: 0) by Anonymous Coward on Tuesday May 05 2015, @07:12PM
> 87491 Chylmd trach dna amp probe
A little penicillin will clear that up.
(Score: 2) by Dunbal on Tuesday May 05 2015, @07:59PM
azithromycin for chlamydia, actually :)
(Score: 0) by Anonymous Coward on Tuesday May 05 2015, @08:25PM
I'd googled the codes too. This isn't indecipherable, but it's inconvenient, which means it's a user interface problem, and I think that's what the author of the article is getting at. Really, how hard would it be for medical billers to pull a brief, simple English description of each CPT code from a table and print them on the bill? The codes exist to provide a standardized ID, and ID's are good for table lookups, and table lookups are good for providing text descriptions. There's absolutely no reason why medical billing shouldn't be able to print "Chlamydia (sexually transmitted disease) test using amplified probe technique" instead of the CPT.
It's kind of like course numbers in college. There's no point now to having ENG1131 written anywhere, since the databases that run school records ought to be able to print a more descriptive title. And that doesn't mean a thirty-character-max all-upper-case abbreviated description like BAS DB KNOW AND SKLS, but a real, human-friendly title, like "Basic Database Knowledge and Skills."
(Score: 1) by nethead on Wednesday May 06 2015, @04:08AM
Of course it's going to be BAS DB KNOW AND SKLS. You have to take ENG1231 ADV DB KNOW AND SKLS to get the computer to output "Basic Database Knowledge and Skills."
How did my SN UID end up over 3 times my /. UID?