Search the Internet for information on hospital billing or medical billing advocacy, and you’ll come up with sites telling many of the same stories again and again. You’ll find tales of outrageous equipment costs like the teddy-bear pillow charged as a “cough-support device” (nearly sixty dollars) and the costly “mucus recovery system” that turned out to be a box of tissues and, of course, the Thousand Dollar Toothbrush™. You’ll learn of ludicrous procedural charges like the woman whose bill for the delivery of her baby girl included the price of a circumcision and the man whose heart surgery included a charge for 200 artificial valves.
All these tales are colorful and fantastic and horrifying. Despite being repeated as often as urban legends, they’re even believable. But really, they didn’t concern me. Those were just those unfortunate people you see on the news. I’m not a news story. I’m just a regular guy. Besides, I’d talked to my surgeon and discussed my bills with hospital billing staff. They’re all reasonable, professional, caring people. They weren’t going to do anything like that to me.
I still can’t believe I was so wrong.
How wrong? Would you believe the very first item on my itemized bill was a $1,000 error? Or that the first two pages of my bills contained over $5,000 in double-billed charges?
Honestly, when I first looked, I didn’t know what I was seeing. Each entry included unfamiliar terms like arthrodesis, obscure abbreviations like TLSO and DOS, and incomplete descriptions like Posterior non-segmental instrume. Then there were all the insurance terms clouding who paid what: conveyance, adjustment, payment, payment on account. Finally, what was with the column labeled Code? The bill wasn’t entirely gibberish, but it may as well have been. I consider myself an intelligent individual. I have a Masters degree in English, have studied several languages, have worked in numerous technical fields, and I’m comfortable speaking with just about anyone on any topic. In these medical bills, I was lost. Completely lost.
One key, I eventually discovered, was those Code columns. As if matters weren’t already complicated enough, the codes in my bills turned out to be of four different types. In the doctor’s bills, procedures and services are coded using the AMA’s Current Procedural Terminology (CPT) codes. Hospitals, on the other hand, may code their procedures using the International Classification of Diseases, Clinical Modification (ICD-9-CM). Others might use the National Drug Code (NDC) for medication. Both types of bills use part of the Healthcare Common Procedure Coding System (HCPCS—called “Hick-Picks”) to code prosthetics and ambulance services.
It’s enough to make you believe they’re trying to hide something.
Possibly, but in truth, the main goal of these code systems is to simplify billing and clarify terms. Many surgical procedures, for example, differ in subtle ways. Those procedures might have dramatically different requirements in terms of time and equipment. The only way to be sure which procedure is which, is to describe them in quite a bit of detail. So, for a procedure that a doctor might describe as
Endovascular repair of descending thoracic aorta not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extensions, if required, to level of celiac artery origin
a coder will instead assign the much simpler (if you have the code books) CPT code 33881.
Great, so the codes simplify everything for the billing people. They certainly complicate matters for the rest of us. At least, that was my initial response. Then I found that all four types of codes have look-up sites available online.