I feel the time has come for me to discuss something that I’m not sure is ethical or not. That something is whether medical providers should be giving diagnosis codes or procedure codes to patients for services that they have provided.

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After recently helping another person who, as a patient, had multiple procedures with multiple providers and a non-traditional insurance figure out the procedure codes for the services performed, I started to wonder why these entities weren’t providing these codes to the patients in the first place. After all, if they were going to bill a traditional insurance company such as Blue Cross, they would have to provide the codes in order to get paid. If that’s the case, then why won’t they give that same information to patients?

I find it incredible that, in this new world where the big medical discussion has been about transparency, both physicians and other providers of services seem to have forgotten that what people sometimes need is more information in order to get claims paid. I think it’s inherently unfair that patients who either don’t have insurance or have an insurance that the medical providers don’t participate with do not give them the information they need to possibility obtain payment from someone else. It’s almost like they’re pretty much letting patients know that if they’re not going to get the money directly then its not their responsibility to help. That’s just not right.

I say this knowing that a patient who has services at a hospital has the right to get those codes by requesting a fully itemized bill. They’ll usually contain the diagnosis codes but some hospitals don’t provide CPT codes unless asked. I also know that there are many physician’s groups that supply both diagnosis and procedure codes after having services performed before they leave, in case they have a copay or need to make another appointment. So, it’s not all providers… but there’s enough of them so that I have patients contacting me for help.

Luckily, I can help patients figure out procedure codes because I’m a charge master consultant. However, there’s absolutely nothing I can do to help patients figure out diagnosis codes, not only because I’m not a certified coder but because I don’t have access to the medical records to even begin to try to help. Patients can get access to their medical records, but by law medical providers are allowed to charge them to print out those records.

I don’t necessarily have a problem with that, until you realize that they are not required to print out anything that they personally didn’t produce. Therefore, if they sent you to a radiologist or to get lab tests, and it was sent back to them, they’re under no obligation to give it to you, let alone even acknowledge that they ever received it.

And we wonder why patients don’t trust health care…

I don’t mind helping patients figure out what codes they need to add to whatever paperwork it is that they have to send their insurance companies to try to get payment. However, that shouldn’t really be my job, but the job of whoever provided the service. I don’t know if there’s a law saying that they have to put procedure codes in medical records, but it should be a common practice for every type of medical practice regardless of whether it’s mandated or not. Trust me, they all know what the codes are when all is said and done.
 

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