Front Office Procedures Coding and Insurance

Coding consists of . . . Diagnostic Coding Procedural Coding

What is Diagnostic coding??? Coding is converting verbal or written descriptions into numeric designations

784 is the diagnostic code for. . . For example: 784 is the diagnostic code for. . .

Headache Ouch! Headache!

An insured patient goes to see his doctor for a headache. This is how it works- An insured patient goes to see his doctor for a headache. Then Doctor X gives the headache a code number (784) And sends the proper paperwork to the patients’ insurance company with that code number.

ABC Insurance company receives the paper work with the code: 784 Coding . . .yeah! ABC Insurance company receives the paper work with the code: 784 For the patient and one look at the number tells ABC Insurance company that their insured was seen for a 784 Or. . .

OUCH A Head Ache!

Procedure codes Mr. Bean has seen Doctor X several times over the last three years, this makes him an. . . ESTABLSIHED PATIENT

Mr. Bean saw Doctor X for a short visit –about 15 minutes Procedure codes Mr. Bean saw Doctor X for a short visit –about 15 minutes And he only had one problem to discuss with the doctor Mr. Bean’s visit was a problem focused, limited exam

Procedure codes –yippee! So Doctor X sends this information to Mr. Bean’s Insurance company as well, in the form of a number. This number is for the procedure It is called a Procedure Code 99212

Codes, codes, codes Once ABC Insurance Company receives the paper work, called a claim, they review the code numbers and . . .

Decide what to pay Doctor X Codes, codes, codes Decide what to pay Doctor X

Doctor X bills ABC Insurance Co. $175.00 for an office visit Amount due: Doctor X bills ABC Insurance Co. $175.00 for an office visit ABC Insurance Co. only has to pay Doctor X a portion of that amount. They decide to pay. . .

payment $75.00

Everyones happy

Because The doctor gets paid. The patient only has to pay a small amount of money to see his doctor- this is called a Co- pay.

Everyone is happy ABC Insurance will continue to receive monthly amounts of money from Mr. Bean- this is called a premium. AND- Mr. Bean has already paid his deductible, which is an amount of money that Mr. Bean has to pay every year towards his Insurance claims.

Recap- Mr. Bean pays a small amount out of his paycheck every month so that when he goes to see his doctor, Doctor X, he only has to pay a vary small amount called a co- payment. Doctor X’s office collects the co-payments from their patients, like Mr. Bean and the monies collected from the Insurance companies and this is how the office makes money

Insurance coding The End.