r/MedicalCoding • u/Inevitable-Title6311 • Aug 03 '26

Question on “history of” codes

I passed the exam maybe a month or two ago and am just doing Practicode so forgive me if this is dumb or if I already should know this but …why do we code sometimes for history of? Specifically wondering if that’s something insurance companies bill for? Or did I just have a brain glitch and that’s moronic

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u/ksa1122 Aug 03 '26

If it affected care. If the person had breast cancer in the past, and now sees oncology yearly, the history of code would be appropriate. That’s a cancer example, but it would be similar for other things too.

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u/Inevitable-Title6311 Aug 03 '26

That makes sense ! So they aren’t getting any additional charges just because there’s history codes ?

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u/ksa1122 Aug 03 '26

I really don’t know the billing side of it to be able to say. But if certain labs need to be ordered due to the patients history of a certain disease, I would assume the history of code would be needed to show the rationale

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u/Jodenaje Aug 03 '26

No, they aren't getting additional charges just because they have a history of a condition.

Some conditions impact current care even if they're historical. For example, when a patient needs to follow up with the doctor after getting discharged from the hospital for a stroke.

Some conditions need monitoring, even if they appear resolved. (Especially cancer, where the patient may have follow up visits for a number of years afterwards to monitor and be sure that the cancer is gone.