Oh! Those “Billing Codes”: Time to Stand-up for Coded Data

by Gail I. Smith, MA, RHIA, CCS-P

I was leisurely reading my April edition of Real Simple magazine and came across an article called “Don’t Pay a Medical Bill Until You Do These 5 Things.” As a HIM practitioner and a coder of long-standing this, of course, sparked an interest.

The article summarized a list that included advice to research billing codes. The author of the article explained that every medical procedure has a corresponding billing code and if the wrong code was submitted, it may be the reason for a payment denial. A representative from the National Patient Advocate Foundation, who was interviewed for the article, recommended typing the code from the bill into a search tool like findacode.com and seeing if there is a potential error. The final step was to ask your insurer how a procedure needs to be coded to get covered.

Needless to say, this portion of the article caused me to pause. Encouraging patients to evaluate their codes is a major, complicated step for a layperson. How are they expected to translate complicated medical procedures and/or diagnoses into coded data? How would they understand coding guidelines that are essential to accurate and complete coding of a diagnosis or procedure?

It also caused concern about the quality of coded data. We all know that payment plans use codes to determine reimbursement, but who is standing up and supporting coded data for healthcare decisions, research, trending, etc.? This coded data that is so essential to public health, disease tracking, and analysis of healthcare services must be defended for the value of the coded data to be realized. If the only reason to assign a code is to get paid, then our structured data collection system is seriously flawed.

What is the answer? Frankly, I have no idea but an advocacy group that holds the flag for quality data comes to mind.


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About the Author

Gail Smith, MA, RHIA, CCS-P
Gail I. Smith, President of Gail I. Smith Consulting, is a health care consultant with over 30 years experience in the field of coding, education and health information management (HIM). Gail focuses on ICD-10-CM/PCS education with developing online courses, presenting workshops, and performing documentation reviews. She has authored several coding books for CPT and ICD-10-CM and is an AHIMA approved ICD-10-CM/PCS trainer and Academy faculty member.

7 thoughts on “Oh! Those “Billing Codes”: Time to Stand-up for Coded Data

  1. karen elliott - April 24, 2019 at 3:18 pm

    WELL SAID!! as a coder I’m getting frustrated having every code questioned by people who are NOT medical practitioners simply because they are trying to cut a better deal. Frankly I think its time that medical providers start questioning whether or not their payer denials are flat out practicing medicine without a license and taking money from their and our pockets.

    • Connie Leamont - April 27, 2019 at 12:40 am

      Yes! Being the front desk office manager for a chiropractor, and working on getting our billing moved in house, it’s beyond frustrating dealing with the billing codes. The insurance companies seem to randomly deny claims for no reason, and change their codes so frequently we can barely keep up.

  2. Jeannine Cain, MSHI, RHIA, CPHI - April 24, 2019 at 3:26 pm

    I cannot tell you how excited I am to see this post! Our medical coded data is used for so many things and we do need to make sure that the right information is being relayed so the appropriate decisions are made. I wish more people understood this concept – that we are taking the value away from medical codes the more we aim to submit medical codes with the intention of only getting paid. This impacts the quality measures that determine compliance and population health (to name a few) if we do not use them appropriately. This is why we need certified medical coders to be the gatekeepers of all items related to the revenue cycle. #HIMProud

  3. Rachel Cloward MS/MBA RHIA - April 24, 2019 at 3:28 pm

    It is unfortunate that now patients are contacted by physician offices every time a claim is denied and it is the patient’s responsibility to either pay the bill or find out why it wasn’t paid and resolve the issue. My 80+ parents have Medicare and more than one supplemental insurance plan and yet every time they had medical procedures, they have had to resolve billing issues on their own when claims were denied by Medicare. Elderly patients who are not “on-line” are at an extreme disadvantage when it comes to resolving these issues. As the consolidation of both inpatient and ambulatory care continues, ambulatory group practices should invest in certified coding professionals to resolve these claims issues, because leaving it to the patients will result in more and more people not getting the care they need. Many patients cannot afford to pay out-of -pocket, and they have no way to push back if their insurance claims are denied.

  4. Barb Hutchings - April 24, 2019 at 4:10 pm

    Great idea for consumers, I don’t know how you can, but get the message out there !

  5. Beth Ayers - April 30, 2019 at 8:59 pm

    Sometimes I want to swear when I field a phone call from a patient, doctor’s office, or – worse still- patient financial services and their first comment is “It was coded wrong.” Ninety-nine times out of a hundred it was NOT, of course, coded wrong, and the elaborate explanations we have to undertake to get non-coders to understand the issues are frustrating to all parties concerned. When patients are given the notion that there somehow is a random number that can just be changed to their benefit, it’s terribly hard for them to understand that coding is subject to federal (and other) laws and stiff regulations. And it’s especially hard for them to grasp that we code JUST what the physician said – so if there’s a problem, it’s often due to a discrepancy between what their physician is telling them and what was documented in the chart. Will they have the courage to question their physicians? Do they even know how to go about that, especially when the coding may be due to a consultant’s documentation? Coding has been under the radar for so long that we have to learn to respond to articles that brush off our highly specialized work as something negligible – or worse, something easy!
    Thanks for your comments!

  6. Kathy Craig, RHIA, CCS - May 1, 2019 at 12:33 pm

    ICD 10, and its predecessors, is a classification system for diseases and conditions. It was intended for data collection and research. It was decided somewhere along the line to put these codes on the bill and use it for reimbursement! With the advent of DRG’s in the 80’s, the power of the coded data became front and center. Now, most people think medical codes are all about reimbursement. Are we trying to use I 10 for things it was not intended?
    Personally, I see so many great uses for public health and data gathering, but many of these codes are not a priority and overlooked by coders. (Noncompliance with medication/treatment is a big one!) One of the reasons we admissions to inpatient care, is non compliance with medication/treatment!
    However, coders are often, not encouraged to be overly concerned with these types of codes. Management endorses this due to the pressure to get the “bill out.” The coded data for things, like non compliance, are unreliable, so we don’t use it for decision-making like we could.
    I don’t have an answer, but I do think it is a discussion we (HIM) should be having in a much bolder way than we have.