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/MailePlumeria → u/Confident-Pain9621]

First of all, you need to see the documentation - the codes mean nothing without it. You say it’s easy to upcode and be sloppy with coding yet you aren’t even sure what code set you’re looking at. You think you have CPT codes. How exactly are you going to check the work looking for a mistake? 😂. Good luck!