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How can I get a list of CPT codes? Or any medical codes?

My health insurance might be able to cover a surgical procedure needed. But the codes submitted on the treatment proposal aren't covered. It was implied that if the office had a different code for the procedure, the insurance company may cover it. The doctors office aren't helping in getting the correct codes. So, how can I get a list of medical codes to check myself?

 
Anonymous

Asked by Anonymous at 5:29 PM on Jan. 25, 2010 in Health

This question is closed.
Answers (9)
  • I'm a dental hygienist and I know dental codes. Part of my position where I work is to send purchase orders to charities that pay for dental services - I need to know the codes for this.
    What is the procedure you need? What does your insurance cover?
    Dental offices can only submit dental codes to insurance and medical offices can only submit medical codes to insurance. The exception is the oral surgron office which can submit both. For example - a patient has been in an accident and their mandible (jaw bone) is broken - the broken bone would be considered a medical condition but the oral surgeon would be the doctor that the patient sees.
    It's the attending doctor that decides which code is used for the procedure - the insurance biller in the office cannot change the codes for insurance purposes. Changing a code for insurance purposes is considered insurance fraud.
    PrttyMstng

    Answer by PrttyMstng at 6:12 AM on Jan. 26, 2010

  • I'm confused, do you mean that you want to have a surgery that your insurance won't cover so you want to use a code for a different procedure so the insurance will cover it?
    Anonymous

    Answer by Anonymous at 5:38 PM on Jan. 25, 2010

  • no. that's illegal and not what i want to do. the surgery is dental but its caused by a genetic disorder which is medical. so because the doctor is listing it as dental surgery the insurance won't cover it. but i was told by the insurance company that if the office changed the code to the medical side that they would possibly cover it. but then i spoke to the dr office and they keep telling me to go the the insurance company. which sends me back in a circle. i just want to assist in the receptionist doing her job since she won't do it.

    Anonymous

    Answer by Anonymous at 6:18 PM on Jan. 25, 2010

  • also, she's using the code for pulpotomy. and it's not. pulpotomy is nerve treatment that's not the procedure i'm having.

    Anonymous

    Answer by Anonymous at 6:31 PM on Jan. 25, 2010

  • Ok, I think I understand now....you need to talk to the DENTIST. Make sure he understands that it needs to be coded medical and not dental. Dental uses HCPCS codes almost exclusively and they will need to find the right code for the procedure in the CPT.
    What is the procedure you need the code for? I can look it up for you.

    This is sort of like a diabetic getting an eye appointment. Diabetics need to have close watch kept on their eyes...therefore it is coded as a medical appointment and not a specialty appointment.

    You need treatment for a medical condition from a dentist. So naturally you are going to have to push them to see your side. Sorry about that. :(
    Anonymous

    Answer by Anonymous at 3:03 AM on Jan. 26, 2010

  • Oh..and the receptionist cannot code, please don't ask her to. The coder is a specialty position. :( She could lose her job for coding without certification.
    Anonymous

    Answer by Anonymous at 3:05 AM on Jan. 26, 2010

  • I forgot to say.... it will be very hard to find the CPT codes on the internet. They are owned by the AMA and they don't want everyone to get access to them for free, but they will sell you a book. :(
    Anonymous

    Answer by Anonymous at 3:20 AM on Jan. 26, 2010

  • Many times the same procedure will have different codes with just slightly different meaning. It isn't that you are summiting a code for a different procedure. Often doctors office just summit the same code all the time even if it doesn't exactly fit what you are having done. The only place to find what is covered is through the insurance company. Ask them if a procedure is covered and what codes are acceptable, they may tell you. I would not summit any codes that do not match the procedure you had done.

    RyansMom001

    Answer by RyansMom001 at 6:22 AM on Jan. 26, 2010

  • I'm confused - they are using the code for pulpotomy for your procedure? A pulpotomy is a root canal done on a primary (baby) tooth. When submitting to insurance they will have to use the dental code for the tooth that is being worked on as well as the code for the procedure. If it is not a primary tooth the insurance company will deny the claim. Dental xrays are usually sent to insurance companies along with the claim for evaluation when the procedure is for a pulpotomy or a root canal.
    Are they sending dental xrays with the claim?
    I have 22 years in dental and have never heard of different codes with slightly different meanings - at least not in dental. The costs can vary greatly too. For example - a simple extraction may cost $125 and a surgical extraction may cost $250 - treatment is different because surgical is more involved than simple. It's important to submit the correct code or insurance may deny it.
    PrttyMstng

    Answer by PrttyMstng at 7:47 AM on Jan. 26, 2010

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