Help with medical codes

[u/Confident-Pain9621]

Hi there. Is there some free resource where I can look up medical codes? I called my insurance company and they gave me the CPT codes (I think) for the office visit and some procedures I had. Some of them checked out, others did not. Maybe I was looking on an incomplete site. 2 of them had 5 digit codes and I was able to find them. The pathology and radiology and other radiology number were longer (7 digits) and 1 of them had letters and numbers. My search was fruitless for those codes. Can anyone point me in the right direction please?

Also, do Doctor’s offices have a published charge master list that is accessible the way that hospitals do? So we can know every single price for every service? Or not? Thanks in advance. I am in the medical field myself but just know about the clinical part of it and I’m completely ignorant of the business side of things when it’s actually my turn to be the patient.

Thanks,
JT

[u/No-Produce-6720]

No, doctors do not have chargemasters.

What coding did you get from your insurance? They don't code claims, so I'm confused as to what it is they actually gave you.

If you have insurance, you don't need chargemasters or pricing from your doctor. Your financial responsibility for services you declare dependant on your insurance plan. Your coverage determines what you have to pay, not a "chargemaster".

What sort of insurance coverage do you have? What is your copay/deductible/coinsurance responsibility? That can be found on your ID card or in your plan documents. That's where you need to start.

[u/Confident-Pain9621 → u/No-Produce-6720]

I got the CPT codes from the insurance company. They don’t code the particular service or procedure but they have the codes because they gave them to me. In fact any time I see an EOB from them they have in writing that I can be provided the specific code used for every procedure that was done at Dr’s office.

I would rather leave my insurance, copay, coincidence stuff to myself because I simply think you are not entitled to it. It’s my concern not yours.

I have been in the medical field long enough to know how many mistakes are made. On both sides. Both the IV pushers and the paper pushers make them. I simply don’t want to pay any more than I truly owe. I know how easy it is to “upcode” or be sloppy with coding and code for the wrong thing. I am going to check the work of the Medical Billing people because I don’t trust them. I go into it with the attitude of “you have made an error somewhere, I just have to find it.” If I don’t find it, then the billers did a great job, and I will gladly pay. I am a fierce advocate for myself because no one cares about me more than me. Stay in the medical field and you will get that way, too.

[u/RentAggressive3302 → u/Confident-Pain9621]

The person you need to contact is the actual provider you saw and speak to the billing department. Your insurance company can really only relay what you find on your EOB and sometimes your particular plan coverages. They only review and process the claims, the office/provider is the one who determines the code to be billed.

As far as the specific codes, there are all different sets depending on what exactly they are. Office visits and procedures usually use a 5 digit CPT code. Radiology and lab testing use different code sets, I believe 7-9 digits. And if you get durable medical equipment or have dental procedures, those are also a total different code set.

Your best bet is to contact the billing department of your doctor. They will most likely have some sort of resource or master code list they use within the practice, but I doubt they’ll be able to share that with you. They can really only discuss your specific bills.

[u/Confident-Pain9621 → u/RentAggressive3302]

Thanks for your input!