Cracking the Medical Billing Code

First, I better own up to that being a very misleading headline. I am far from cracking the code (and I used to write documentation for medical billing software!), but I did notice something that didn’t add up when I had a mammogram a couple of weeks ago.

I mentioned in a recent post that when I went in for my second annual postmastectomy screening, the tech told me they needed to code it as diagnostic because of my implant. In that post, I wondered whether the diagnostic mammogram would be more expensive.

I found out it was not; however, the full covered cost was applied to my deductible, leaving me responsible for $145. I asked my insurance provider if the full cost of the routine screening also would have been applied to my deductible. The phone rep said I would only have been responsible for a 10 percent copay, or roughly $14. So I called the medical center billing department and asked them to go back and question the diagnostic code.

Implant or no implant, the reason for my visit was my routine annual screening. I don’t know if they’re using this coding for anyone with implants or if it was just me, but I feel like I landed in the middle of a Kafka novel. If I don’t get a satisfactory explanation, I will argue this one until the cows come home.

The funny thing is I went through $83,000 worth of demolition and reconstruction and never ran into anything this goofy until now.

I mentioned this was my second annual postmastectomy mammogram. You may be wondering whether something’s changed since the first one, and I wish I could tell you. I think I was just so relieved the results were normal that I didn’t pay attention. It’s quite possible I paid a $145 stupidity tax.

Don’t be like me. Whether it’s your breast cancer, your husband’s gallbladder or your child’s asthma, pay attention to those bills. If they don’t make sense, get someone on the phone and make them explain it.

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One thought on “Cracking the Medical Billing Code

  1. Pingback: How Did Your Doctor Break the News About Your Breast Cancer? « Dispatch From Second Base

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