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Are people really billed based on diagnostic codes? If true, it’s not what ICD-10 was designed for.

Patient A can recover from the same procedure for the same diagnosis much quicker and with fewer interventions than Patient B. Would insureco get billed the same for both?



They aren't. Prices are based on the HCPCS codes (CPT for clinical charges). For example, a 99213 is a return office visit.


Providers often enter ICD-10 codes (required by Epic) and do not know HCPCS or CPT... so how could they tell you what you will be charged? There isn't a way (that even educators know of to get those codes or the pricing)... the prices are handled by billing, which is a separate department and you can't reach them by phone. They will call you back (within 30days), but they do not leave messages.

Clinic and hospital in the heart of silicon valley.




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